Impact of Suboptimal Graft Function at 1 Month Post-Transplantation on Long-Term Outcomes in Living Donor Kidney Transplant Recipients: A Retrospective Cohort Study.

Introduction: While most recipients of living donor kidney transplantation experience rapid recovery of renal function, a subset shows suboptimal recovery of graft function despite sufficient postoperative time. The long-term implications of this suboptimal recovery of graft function remain unclear. This study aimed to assess the long-term outcomes of patients with suboptimal renal function 1-month post-transplantation.

Methods: This retrospective cohort study analyzed 411 living donor kidney transplant recipients at a single center from January 2006 to February 2014, with a mean follow-up of 11.3 years. Patients were categorized into 2 groups based on 1-month post-transplant serum creatinine: suboptimal (>1.2 mg/dL) and standard (≤1.2 mg/dL). Clinical, immunological, and donor-recipient variables were compared. Primary outcomes included acute rejection, graft survival, and patient survival. Kaplan-Meier and log-rank analysis were used for outcome assessment.

Results: The suboptimal group comprised 84 patients (20.4%). They were younger, predominantly male, had higher body mass index, and more frequently received smaller grafts from older donors with lower donor-to-recipient weight ratios. Acute rejection within 1 month occurred more frequently in this group (8.3% vs. 1.8%, P = .007). Despite these differences, no significant differences were observed in graft failure, mortality, infections, or malignancies, and long-term graft or patient survival did not differ significantly between the suboptimal and standard groups.

Conclusions: Suboptimal graft function at 1-month post-transplantation is associated with increased acute rejection but does not independently predict inferior long-term graft or patient survival. These findings suggest that long-term outcomes can be preserved despite suboptimal functional recovery.