Center / Patient ID
Induction: Thymo / Dac
Baseline characteristics
Cause of ESRD
Pre-emptive transplantation yes / no
Duration of dialysis
Date of Transplant
Recipient: Age / Sex / Race
Donor: Age /Sex / Source (Deceased / Living Related / Living Unrelated)
Recipient and donor HLA / Total # mismatches
PRA: assay used / Peak / at transplant for class I and II
Cold Ischemia time
Delayed Graft Function: Yes / No
Maintenance immunosuppression
Time 0
Creatinine / height /weight
Neutrophil count / lymphocyte count / total white cell count
Blood pressure / No. of anti-hypertensives
Protein Creatinine ratio (Urine)
Day 1-5: Daily
Creatinine
Absolute CD3 count
Neutrophil count / lymphocyte count / total white cell count
Monthly
CMV / EBV / BK serum quantitative PCR values
Creatinine / height / weight
Time: 3m
Creatinine / height /weight
Neutrophil count / lymphocyte count / total white cell count
Blood pressure / No. of anti-hypertensives
Protein Creatinine ratio (Urine)
Biopsy Findings: (AR / CAN / CNIT / C4D / CD20 / polyoma virus /normal /other)
DSA
Time: 6m
Creatinine / height /weight
Neutrophil count / lymphocyte count / total white cell count
Blood pressure / No. of anti-hypertensives
Protein Creatinine ratio (Urine)
Biopsy Findings: (AR / CAN / CNIT / C4D / CD20 / polyoma virus /normal /other)
DSA
Time: 12m
Creatinine / height /weight
Neutrophil count / lymphocyte count / total white cell count
Blood pressure / No. of anti-hypertensives
Protein Creatinine ratio (Urine)
Biopsy Findings: (AR / CAN / CNIT / C4D / CD20 / polyoma virus /normal /other)
DSA
Time: 18 m
Creatinine / height /weight
Neutrophil count / lymphocyte count / total white cell count
Blood pressure / No. of anti-hypertensives
Protein Creatinine ratio (Urine)
Time: 3m
Creatinine / height /weight
Neutrophil count / lymphocyte count / total white cell count
Blood pressure / No. of anti-hypertensives
Protein Creatinine ratio (Urine)
Biopsy Findings: (AR / CAN / CNIT / C4D / CD20 / polyoma virus /normal /other)
DSA
Report:
- Any viral or bacterial illness: date / requiring hospitalization (length of stay) /
- Biopsy outside protocol: Date / indication / Creatinine / Height / weight / DSA / Biopsy findings
- Any hospitalization: Cause / date / length of stay
- Other adverse events: Diabetes etc.