Pre-transplant risk factors for renal allograft dysfunction at one year inIndian patients

Background. Only a few patients with end-stage renal disease in the Indian subcontinent receive optimal treatment. Of these only a minority can afford a second renal transplant. Awareness of modifiable pre-transplant risk fac tors that influence allograft function is crucial before embarking on the f irst transplant. There are no reports from the Asian subcontinent describin g the pre-transplant risk factors. Methods. We studied the effect of donor age, gender, and relation with the recipient, patient age, gender, HLA matching, native kidney disease and imm unosuppression on one-year allograft function using data from 1177 consecut ive primary living related donor renal transplants at the Christian Medical College Hospital, Vellore. We performed a univariate followed by a multiva riate analysis using a logistic regression model to calculate the odds rati o for the effect of the above factors on two levels of graft function (seru m creatinine > 1.4 mg/dl and >2 mg/dl) at one year. Results. On univariate analysis, older donors, women donors, mother being t he donor, men recipients, < 1 HLA antigen match, cyclosporine-based immunos uppression and patient age between 16 and 40 years were associated with ser um creatinine levels > 1.4 mg/dl at one year. Multivariate analysis showed that donor-related factors, namely mother as donor, older donors, and a les s than or equal to1 HLA antigen match, were risk factors for graft dysfunct ion (serum creatinine level >1.4 mg/dl) at one year. Recipient-related risk factors were male patients and those between the age of 16 and 40 years. Conclusion. In patients undergoing living related donor renal transplants f rom large extended families, a younger haplomatched donor, for instance, a brother, is a better choice than an older haplomatched donor, for instance, the mother, particularly in young male recipients at a higher risk of rena l dysfunction.