ASN's Mission

ASN leads the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on Twitter

Kidney Week

Abstract: PO2540

Impact of Renal Transplantation on Functional Status in Tacrolimus Era

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Mohamed, Mahmoud Magdy, The University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Soliman, Karim Magdy, Medical University of South Carolina, Charleston, South Carolina, United States
  • Ali, Hatem, University hospitals of Birmingham, UK, Birmingham, Birmingham, United Kingdom
  • Daoud, Ahmed, Cairo University Kasr Alainy Faculty of Medicine, Cairo, Egypt
  • Fulop, Tibor, Medical University of South Carolina, Charleston, South Carolina, United States
  • Rao, Vinaya, Medical University of South Carolina, Charleston, South Carolina, United States
  • Posadas, Maria Aurora C., Medical University of South Carolina, Charleston, South Carolina, United States
  • Casey, Michael, Medical University of South Carolina, Charleston, South Carolina, United States
  • Halawa, Ahmed, 1Institute of Medical Sciences, Faculty of Medicine, University of Liverpool, Liverpool, UK, Liverpool, Liverpool, United Kingdom
  • Elsayed, Ingi, Royal Stoke University Hospital, Stoke-on-Trent, Staffordshire, United Kingdom
Background

Despite a large body of literature describing survival’s outcome after renal transplantation, little is known about the progress of functional capacity post-transplant. Our aim is to assess the effect of renal transplantation and various factors on functional capacity.

Methods

From the United States Organ Procurement and Transplantation Network files, we identified a total of 19,704 renal transplant recipients (RTR) maintained on tacrolimus-based immunotherapy, who had Karnofsky Performance Status Scale (KPSS) defined functional capacity assessment at the time of transplant evaluation with five-years data follow up. Age, gender, ethnicity, functional status, diabetes, body mass index, cold ischemia time, number of previous transplants, panel reactive antibodies, donor type, donor age, HLA-mismatches, number of acute rejection episodes, induction therapies, maintenance immunotherapy on discharge were collected. According to KPSS, RTRs at time of transplant evaluation were divided into 3 groups (A: 13,701 RTRs with mild impairment: >80%, B: 5,557 RTRs with moderate impairment: 40-80%, C: 446 RTRs with severe impairment: <40%). The outcome measured was KPSS functional status five-years post-transplant. Multiple logistic regression analysis was used to assess factors affecting functional status post-transplant.

Results

In group A, 86.45% of patients showed improvement in functional capacity, 65.5% in group B, while 88.56% improved in group C (64.57% improved from severe to mild and 23.99% improved from severe to moderate functional capacity). Furthermore, multiple logistic regression analysis showed that steroid withdrawal protocol was associated with significant improvement in functional capacity (OR=1.28, 95% Confidence Interval (95% CI): 1.1 - 1.49; P=0.007), while dialysis duration before transplantation was associated with abnormal functional capacity post-transplant (OR=0.74, 95% CI: 0.61 - 0.89; P=0.003).

Conclusion

Renal transplantation is associated with substantial improvement in all stages of functional capacity in RTRs. Steroid withdrawal as well as the duration of dialysis are important novel determinant factors of functional capacity post-transplant and merit considerations during transplant selection and subsequent immunosuppressive therapeutic planning.