341.11: Prognostic factors in living donor kidney transplantation (LDKT): Preliminary data for the use of slow graft function (SGF) as a decision-making tool.

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Background: The level of function of a transplanted kidney in the immediate postoperative period is correlated with long-term graft and patient survival. In LDKTs (living donor kidney transplantation), the transplanted kidney develops graft function relatively quickly, with the first output of urine usually obtained intraoperatively. However, the rate of decrease in serum creatinine level varies among recipients, historically classified by the presence or absence of DGF (delayed graft function). Many patients, by default, are considered to have “adequate” graft function if they avoid dialysis. An intermediate phenotype, known as slow graft function (SGF), can be characterized by slower initial postoperative decline in serum creatinine (Cr) compared to immediate graft function (IGF) but without the need for dialysis. Methods: We investigated the potential utility of creatinine trend in LDKT by examining how SGF was associated with long-term patient and graft survival. We utilized a monocentric, retrospective cohort of 42 patients undergoing LDKT from January 2013 to December 2022, for whom data long-term follow-up was available. From these sources, donor and recipient risk factors commonly associated with outcomes were collected. We hypothesized that SGF would have a strong association with graft and patient survival as compared to IGF and DGF. Results: 16 women and 18 men underwent LKDT, with a mean age of 47.4 years (19 - 67). The hospital stay averaged 14 days (7 - 60). Standard induction therapy: basiliximab, methylprednisolone, mycophenolic acid, and tacrolimus. One patient developed PNF. No differences in terms of rejection were observed. Post-transplant estimated glomerular filtration rates tended to decrease sooner with SGF than with IGF. Conclusions: Appreciation of SGF as a distinct phenotype permits a finer degree of risk stratification for long-term graft and patient outcomes and, perhaps more practically, might influence early therapeutic decisions. Important information may be lost if patients are classified using traditional systems that merely classify patients by the presence or absence of DGF. Future work should be undertaken to investigate how information from events in the immediate post-transplantation period can be used to improve the prediction of key clinical outcomes.

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