Creatinine reduction ratio: a useful marker to identify medium and high-risk renal transplants

Enric Vilar, Mira Varagunam, Muhammad M Yaqoob, Martin Raftery, Raj Thuraisingham

Research output: Contribution to journalArticlepeer-review

16 Citations (Scopus)


INTRODUCTION: Delayed graft function (DGF) has a major impact on long-term renal transplant survival. However, it is a diagnosis made retrospectively with little opportunity to modify treatment protocols. A classification based on creatinine reduction ratio between days 1 and 2 (CRR2) suggests that patients with CRR2 less than or equal to 30% (nondialysis requiring DGF [ND-DGF]) have similar outcomes to those with dialysis-requiring delayed graft function (D-DGF). We retrospectively applied this definition in our cohort of patients to examine outcomes.

METHODS: We studied the association between CRR2 and graft outcomes in all 367 patients transplanted between 1996 and 2004 at our center. Patients were divided into the following three groups: IGF (immediate graft function; CRR2 >30%), D-DGF, and ND-DGF. Mean follow-up was 4.2 years.

RESULTS: IGF accounted for 36% of patients, D-DGF for 22%, and ND-DGF for 42%. CRR2 was inversely correlated with serum creatinine on days 7, 30, 90, and 365 (r ranging from -0.65 to -0.22, P<0.001). Graft survival at 5 years was 98% (IGF), 74% (D-DGF), and 89% (ND-DGF). There was a significant difference in graft survival between IGF and D-DGF (P<0.001) and IGF and ND-DGF (P=0.005). In a multivariate analysis adjusting for recipient age and sex, donor age and sex, and human leukocyte antigen mismatch, graft failure was 2.4 times more likely to occur in patients with D-DGF than those with ND-DGF(P=0.02).

CONCLUSIONS: Our study shows CRR2 influences long-term graft outcomes. Unlike the original description, patients with ND-DGF carry an intermediate risk and perhaps should be considered on day 2 for alternative treatment protocols.

Original languageEnglish
Pages (from-to)97-103
Number of pages7
JournalCell Transplantation
Issue number1
Publication statusPublished - 15 Jan 2010


  • Adult
  • Biomarkers
  • Cohort Studies
  • Creatinine
  • Delayed Graft Function
  • Drug Therapy, Combination
  • Female
  • Graft Rejection
  • Graft Survival
  • Histocompatibility Testing
  • Humans
  • Immunosuppressive Agents
  • Kidney Transplantation
  • Likelihood Functions
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Retrospective Studies
  • Risk Factors
  • Risk Reduction Behavior
  • Survival Rate
  • Survivors
  • Tissue Donors
  • Treatment Failure


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