Early graft function after laparoscopically procured living donor kidney transplantation

Mark Tyson, Erik Castle, Paul Andrews, Raymond Heilman, Kristin Mekeel, Adyr Moss, David Mulligan, Kunam Reddy

Research output: Contribution to journalArticle

12 Scopus citations

Abstract

Purpose We determined predictors of poor early graft function after laparoscopic living donor kidney transplantation. Materials and Methods We performed an institutional review board approved review of the living donor kidney transplantation database at our institution. Results Seven of the 510 transplants (1%) were excluded from study due to immediate graft nephrectomy for vascular complications. Of the remaining 503 transplants 48 (9.5%) and 18 (3.6%) had slow and delayed graft function, respectively. Recipient male gender (OR 2.03, 95% CI 1.053.91, p = 0.035), black ethnicity (OR 1.59, 95% CI 1.082.34, p = 0.020) and donor age (OR 1.03, 95% CI 1.001.05, p = 0.021) emerged as independent predictors of poor early graft function in multivariate logistic regression models. Poor early graft function strongly redisposed patients to acute rejection during year 1 (HR 3.43, 95% CI 2.045.77, p <0.0001) while grafts from genetically related donors conferred a protective effect (HR 0.40, 95% CI 0.240.66, p <0.0001). Three-year death censored allograft survival was lower in the delayed and slow graft function groups than in the immediate function group (89% and 87% vs 98%, p = 0.0068 and 0.0002, respectively). Overall 3-year patient survival was lower in the delayed than in the immediate function group (81% vs 94%, p <0.0001). Conclusions Male black recipients of laparoscopically procured living donor kidney transplants from donors older than 50 years are at higher risk for poor early graft function, which in turn strongly predicts acute rejection during year 1. This is significant since excellent early graft function confers specific recipient and allograft survival advantages, and may assist physicians in better understanding the various recipient, donor and perioperative parameters that influence clinical outcomes.

Original languageEnglish (US)
Pages (from-to)1434-1439
Number of pages6
JournalJournal of Urology
Volume184
Issue number4
DOIs
StatePublished - Oct 2010

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Keywords

  • African Americans
  • kidney
  • kidney transplantation
  • laparoscopy
  • living donors

ASJC Scopus subject areas

  • Urology

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