Post-reperfusion
inflammation as well as anti-allograft response occur following
kidney transplantation. We evaluated tissue damage by multiple renal indicators and searched for rejection predictors forewarning serum
creatinine upturns. Twenty recipients (43 +/- 9 y; donors' age 35 +/- 16 y) of first renal grafts were studied. All through their
hospital stay (35 +/- 18 d, range 17-75 d) we measured serum levels of
urea,
creatinine and
electrolytes along with urinary excretion rates of total
protein,
albumin,
enzymes (GGT, NAG,
AAP) and
electrolytes. During the period of observation, peaks were seen on the 1st day for serum
creatinine, serum K+ and urine
albumin output; on the 2nd day for urine Na+, GGT,
AAP and
protein excretion rates; on the 4th day for
urea and
creatinine outputs; on the 5th day for NAG output. On the 14th day, serum
urea and
creatinine as well as urine GGT, NAG,
AAP,
albumin and total
protein were still elevated compared to 20 healthy control subjects. Delayed/slow graft function was observed in six recipients with higher pre-
transplantation plasma
lipids and lower donor
HDL cholesterol.
Hospital stay time was correlated with need for post-
transplantation dialysis (p = 0.01) and recipient
proteinuria by time 0 (TO) to day 3 (p = 0.02). Cold ischemia time was positively associated with 0-3 d serum
creatinine, 0-3 d urinary
urea and
protein outputs (multiple r 0.9, p < 0.001). Multivariate analysis of longitudinal data showed that recipients' serum
creatinine was positively correlated (p < 0.001) with urine
AAP and negatively correlated with urine
albumin, with diuresis volume and urine
creatinine (p < 0.01). Serum
creatinine elevations were preceded (previous 1-7 d) by increases in urinary indicators, the probability being higher in the presence of multiple simultaneous abnormalities. Useful parameters predictive of favorable graft outcome prior to
transplantation included a brief cold ischemia time and a normal donor/recipient serum
lipoprotein profile. Following
transplantation, useful parameters were a high diuresis volume at time zero along with low urine NAG and high
albumin outputs; early (first opst-graft 3 d)
polyuria, low
urea and GGT, high K, NAG and total
protein excretions.