Abstract: TH-PO1011

Dynamic Creatinine Clearance Calculation Enables Early Assessment of Kidney Function and Advances Detection of Functional Decline After Renal Transplantation

Session Information

Category: Transplantation

  • 1702 Transplantation: Clinical and Translational

Authors

  • Beele, Paul, UMCU, Utrecht, Netherlands
  • Van Zuilen, Arjan D., UMCU, Utrecht, Netherlands
  • Rookmaaker, Maarten B., UMCU, Utrecht, Netherlands
Background

Immediately after renal transplantation (RTX), graft function can be compromised for which early intervention can be crucial. However, the rapid fall in plasma creatinine concentration immediately after RTX can conceal graft function decline. We present a strategy to estimate creatinine clearance (CCr) immediately after RTX and advance detection of functional decline.

Methods

CCr was derived from 2 subsequent plasma creatinine levels over time using a newly developed method for Dynamic Creatinine Clearance Calculation (D3C) (Fig1A). We estimated CCr one day (T1) after RTX by D3C and correlated this to the estimated CCr using CG at T12 in 154 uncomplicated RTX patients. We also investigated whether monitoring of D3C could advance detection of functional decline in patients with early rejection.

Results

Average plasma creatinine at T1 was 350±204µM and 155±75µM at T12. D3C at T1 was 50±22ml/min whereas CG estimated CCr was 59±21ml/min at T12. D3C at T1 correlated to GC estimated Ccr at T12 (R=0.741, R2=54,9%, p=0.000) (Fig1B), improving upon plasma creatinine correlation at T1 and T12 (R=0.661, R2=43.7%, p=0.000).
Detection of functional decline was advanced by identifying a decreasing D3C over time as compared to an increase in plasma creatinine concentration over time. This is illustrated by 2 patients with biopsy proven rejection (Fig1C,D) and 2 uncomplicated transplantations (Fig1E,F).

Conclusion

One day after RTX D3C significantly correlates to CG estimated Ccr at T12 in uncomplicated RTX patients. Moreover, monitoring of renal function using D3C after RTX advances detection of functional decline on average by 2 days, expediting therapeutic intervention and conceivably improving clinical outcome.

Figure 1A-F