Increase in Proteinuria After Acute Kidney Graft Rejection is Associated With Decreased Graft Function and Survival

Abstract Background There are limited data on the relationship between acute kidney graft rejection, proteinuria, and outcome. We hypothesized that an increase in proteinuria after an acute rejection episode is associated with decreased graft function and survival. Methods We tested our hypothesis i...

Full description

Saved in:
Bibliographic Details
Published in:Transplantation proceedings 2013-05, Vol.45 (4), p.1453-1457
Main Authors: Oblak, M, Kandus, A, Mlinšek, G, Buturović-Ponikvar, J, Arnol, M
Format: Article
Language:English
Subjects:
Adult
Female
Graft Rejection
Graft Survival
Humans
Kidney Transplantation
Male
Middle Aged
Proteinuria - physiopathology
Surgery
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Abstract Background There are limited data on the relationship between acute kidney graft rejection, proteinuria, and outcome. We hypothesized that an increase in proteinuria after an acute rejection episode is associated with decreased graft function and survival. Methods We tested our hypothesis in a national historic cohort study of 506 recipients of deceased donor kidney transplantations between January 2000 and December 2010. The selection criterion was a biopsy-confirmed first acute rejection episode. Proteinuria was measured using urine protein/creatinine ratios (UPCR) at baseline (lowest serum creatinine before biopsy), time of biopsy, and 3 months thereafter. We examined the effects on outcomes of a change in UPCR (ΔUPCR = UPCR at 3 months after biopsy − baseline UPCR). Results In the observed period, 86 patients experienced a biopsy-confirmed acute rejection episode. Three patients with primary graft nonfunction were excluded. Among the remaining 83 patients the median time to acute rejection was 6 (interquartile range, 2–39) months, and median follow-up was 60 (interquartile range, 35–124) months. Receiver operator characteristic analysis demonstrated that ΔUPCR cutoff value of 20 mg/mmol showed the best discriminatory ability to predict graft loss or patient death (sensitivity, 84%; specificity, 73%). There were 41 patients with ΔUPCR ≥20 mg/mmol, whereas 42 patients had ΔUPCR
ISSN:0041-1345
1873-2623
DOI:10.1016/j.transproceed.2013.02.106