Effect of Residual Renal Function on Long Term Patient and Graft Survival in Patients with Preemptive Renal Transplants

Increasing incidence of chronic renal failure and its' high morbidity and mortality are serious public health issues. As well, the incidence of end-stage renal disease is also increasing worldwide. Renal transplantation is the main stray of renal replacement therapies. Preemptive renal transplantations definesthat the transplantation was done before the development of ESRD and other renal replacement therapies such as hemodialysis. Preemptive renal transplantation was previously shown to be better than transplantation after dialysis in terms of patient and graft survival, acute rejection rates and transplantation costs. Preemptive renal transplantation helps to set the transplantation time in patients with ESRD. Although renal transplant has lots of positive aspects, the need to use immunosuppresives lifelong and follow up, possibility of acute and chronic allograft rejections even in the setting of stong immunosupression, infections, lymphoproliferative malignancies and cardiovascular problems are the burdens for transplant patients. In this retrospective analysis, patients underwent preemptive renal transplant between January 2006 and June 2015 were analyzed for residual renal functions, acute and chronic rejection rates, infectious and surgical complications; and their effects on patient and graft survival. 276 patients over 18 years old were included in this analysis, median follow-up was 46 months. Patients were divided into groups according to their pre-transplant GFR levels: 120 patients were included in GFR <10 ml/min/1.73 m 2 , 115 patients were included in GFR ≥ 10 and <15 ml/min/1.73 m 2 and 41 patients were included in GFR ≥15 ml/min/1.73 m 2 . We determined that patients with high GFR (>15 ml/min/1.73 m 2 ) had better renal functions after the first year of transplant, however this difference was diminished after the first year, even reduced to lower levels than patients with GFR 10-15 ml/min/1.73 m 2 . Patients with pre-transplant GFR of 10-15 ml/min/1.73 m 2 had stable GFR progress post-transplantation. Although patients with GFR >15 ml/min/1.73 m 2 seemed to have both patient and graft survival benefits than other two groups, this statistically significant difference was diminished in time. We conclude that patients undergoing preemptive renal transplant with higher GFR levels have better patient and graft survival ratios, however this difference is reduced after years of renal transplant.