Creatinine reduction ratio on day 2 (CRR2) has been used to describe early function in renal transplantation. The purpose of this study was to determine the utility of creatinine reduction ratio (CRR6) between an immediate post-op creatinine (Cr0) and creatinine 6 hours later (Cr6). Criteria for immediate (IGF), slow (SGF), or delayed (DGF) graft function were determined as previously described (Govani, et al, JASN 2002:13;1645). CRR6 was first determined in living donors with immediate graft function, then applied to the cohort of DDKT. All DDKT kidneys were pumped, and pediatric en bloc kidneys were excluded. Based on a mean (±SD) CRR6 in living donors of 19±11%, IGF using CRR6 was defined as > -3% (i.e. 2 SD below 19%), SGF was defined as CRR6< -3% without the need for dialysis, and DGF was defined as the requirement of dialysis in the first week. Characteristics of the 219 DDKT include: mean age 51 years, 36% African American, 30% Caucasian, 61% male, 11% retransplants. Donor factors include: mean age 38 years, 43% death due to trauma, mean ischemia time of 21 hours, and terminal creatinine 1.1 mg/dL. According to CRR2, 114(52%) patient had IGF, 77(35%) SGF and 28(13%) had DGF. When grouped according to CRR6, 156(71%) had IGF, 35(16%) SGF and 28(13%) had DGF. A significant correlation was seen between CRR6 and CRR2 (fig. 1). GFR in the IGF group was significantly higher than both SGF and DGF patients at all time points, regardless of whether CRR2 or CRR6 was used (fig.2). In contrast, renal function did not differ between SGF and DGF at any time point. Creatinine reduction 6 hours post-op may serve as a marker of early graft dysfunction extending through the first year. This tool may help identify patients early after transplant in whom new interventions to attenuate acute tubular necrosis could be utilized.

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