Test Results Graft Function

*Timeline requirements for this form are as follows:
Assessment timeframe: : Weekly through Month 24 if tacrolimus has been discontinued; Every 2 weeks in Month 27, Month 30, Month 33, Month 36, Month 48, Month 60.

Submission timeframe:

Serum Creatinine _______ mg/dL
Enter the serum creatinine value in the “NNNNN” format. This format allows for five digits before the decimal and zero digits after the decimal.

eGFR _______
Enter the eFGR value in the “NN” format. This format allows for two digits before the decimal and zero digits after the decimal.

Is recipient female
Indicate if the recipient is female.

Is recipient African American
Indicate if the recipient is African American. This includes persons having origins in any of the Black racial groups of Africa, including Black Americans, Africans, Haitians, and residents of Caribbean Islands of African descent.

CCG v.1 | CRF v.1

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CIBMTR® (Center for International Blood and Marrow Transplant Research) is a research collaboration between the Medical College of Wisconsin and NMDP.