IDENTIFICATION OF CLINICAL AND HISTOPATHOLOGIC RISK-FACTORS FOR DIMINISHED RENAL-FUNCTION 2 YEARS POSTTRANSPLANT

The aim of this study was to identify early clinical and pathologic va riates that independently predict diminished renal allograft function at 24 mo posttransplant. A clinical pathologic data base was prospecti vely derived from 71 patients in whom protocol renal biopsies were per formed at 1, 2, 3, 6, and 12 mo posttransplant. The major end point wa s the 24-mo serum creatinine. Variates correlating independently (r(2) = 0.67) with the 24-mo serum creatinine were the chronic biopsy score s (months 3 and 6), late rejections (months 3 to 6), cyclosporin A (Cs A) levels (months 1 to 2), and delayed graft function. The adjusted od ds ratio (OR) and 95% confidence interval (CI) for having a serum crea tinine greater than or equal to 130 mu mol/L at 24 mo increased for ev ery year the donor age increased (OR = 1.07; 95% CI, 1.02 to 1.13; ran ge, 9 to 55) or for each late rejection episode (OR = 5.9; 95% CI, 1.7 to 20.1), whereas a mean CsA level > 300 mu g/L from months 1 to 3 wa s protective (OR = 0.07; 95% CI, 0.01 to 0.43). Variates correlating i ndependently (r(2) = 0.53) with the change in serum creatinine from 6 to 24 mo (Delta Cr6-24) were the chronic biopsy scores at months 3 and 6. The adjusted OR of the Delta Cr6-24 rising greater than or equal t o +20 mu mol/L increased for every year the donor age increased (OR = 1.09; 95% CI, 1.02 to 1.16; range 9 to 56) or when the 6-mo chronic bi opsy score was greater than or equal to 2 (OR = 6.6; 95% CI, 1.2 to 36 .4). An estimate of the relative risk for diminished renal function at 2 yr can be assigned within 6 mo of transplant based on chronic patho logy, late acute rejections, CsA levels, and donor age.