Effect of earlier-proteinuria on graft functions after one-year living donor renal transplantation

Abstract

BackgroundProteinuria is an indicator of subsequent renal function decline in most nephropathies and early proteinuria has been assumed to be a risk factor of poor kidney transplant outcomes. However, there is no information about the effect of earlier-proteinuria at the first week on short-term graft function after living donor renal transplantation.MethodsRetrospective cohort study of 439 living donor kidney transplants to analyze the effect of early proteinuria at 7-day post-transplantation on short-term prognosis of living donor renal transplantation. Patients were stratified into 2 groups according to the definition of earlier-proteinuria: Group A as proteinuria < 0.4 g/24h and Group B as proteinuria ≥ 0.4 g/24h, and differences over the first year post-transplantation were analyzed.ResultsPatients with earlier-proteinuria ≥ 0.4 g/24h had a significantly higher 1-year proteinuria and lower 1-year graft function post-transplantation. Discrepancies of weight ratio of donor-recipient and mean artery pressure difference of recipient to donor influenced the urine protein excretion at the 7-day post-transplantation.ConclusionsEarlier-proteinuria at 7-day after living donor renal transplantation was associated with short-term graft function. To eliminate the functional discrepancies between living donors and recipients could be viewed as a solution of reducing earlier-proteinuria.

Clinical relevance of postoperative proteinuria for prediction of early renal outcomes after kidney transplantation

“…The severity of proteinuria after KT has been shown to be inversely associated with graft survival and favorable patient outcomes [2][3][4][13][14][15][16][17][18][19]. Similarly, a recent large cohort study demonstrated that the severity of proteinuria at 3 months, 1 year, 2 years, and 6 years after KT, as well as at the time of allograft biopsy, was inversely associated with graft survival [16].…”

“…However, there were conflicting results regarding the prognostic value of proteinuria at 1 month after KT [4,14]. A few studies have evaluated the clinical value of proteinuria less than 1 month after transplant, and one among them showed an association between proteinuria measured 1 week posttransplant and graft function [15]; however, this study included only LDKT recipients, and proteinuria was assessed using 24-hour urine collection within 1 week posttransplant, but only by qualitative tests were used after 1 month [15]. Our study investigated the clinical value of quantitative measurement of urine protein excretion at different time points, including during the immediate postoperative period.…”