Korean J Transplant.  2023 Nov;37(Suppl 1):S179. 10.4285/ATW2023.F-7663.

Creatinine-cystatin C ratio and death with a functioning graft in kidney transplant recipients

• Choi MC
• Kim DG
• Yim SH
• Kim HJ
• Kim HW
• Yang J
• Kim BS
• Huh KH
• Kim MS
• Lee J

• KMID: 2551799
• DOI: http://doi.org/10.4285/ATW2023.F-7663

Abstract

Background
Given that the number of elderly kidney transplant recipients with multiple comorbidities continues to rise, death with a functioning graft is becoming an increasingly common and important issue. However, little research has focused on death with a functioning graft, an important cause of overall graft loss. Therefore, clinical parameters to reliably identify patients at higher risk of death with a functioning graft are urgently required.
Methods
In this study, we evaluated the association between posttransplant creatinine-cystatin C ratio and death with a functioning graft in 1,592 kidney transplant recipients. We divided the patients into tertiles based on sex-specific creatinine-cystatin C ratio.
Results
Among the 1,592 recipients, 39.5% were female, and 86.1% underwent living donor kidney transplantation. The cut-off value for the lowest creatinine-cystatin C ratio tertile was 0.86 in males and 0.73 in females. The lowest tertile had a significantly lower 5-year patient survival rate and was independently associated with death with a functioning graft (adjusted hazard ratio, 2.574; 95% confidence interval, 1.339–4.950; P<0.001). Infection was the most common cause of death in the lowest tertile group, accounting for 62% of deaths.
Conclusions
A low creatinine-cystatin C ratio was significantly associated with an increased risk of death with a functioning graft after kidney transplantation, and the creatinine-cystatin C ratio can be used as a clinical parameter to predict death with a functioning graft.