Long-term graft function changes in kidney transplant recipients

Abstract

Background. Monitoring changes in glomerular filtration rate (GFR) is the recommended method for assessing the progression of kidney disease. The aim of this study was to assess the decline of graft function defined by the annualized change in GFR and the factors which affect it.Methods. Four thousand four hundred and eighty-eight patients, transplanted during the years 1990, 1994, 1998 and 2002 in 34 centres in Spain with allograft survival of at least 1 year, were included in the study. GFR was estimated using the four-variable equation of the Modification of Diet in Renal Diseases (MDRD) study. Linear mixed effects model was applied to determine the relation between the covariates and the annualized change in GFR after transplantation.Results. The average GFR at 12 months was 51.4 ± 18.9 mL/min/1.73 m2; most patients were in stage 3 of chronic kidney disease classification. The average patient slope, calculated in a linear model with varying-intercept and varying-slope without covariates, was −1.12 ± 0.05 mL/min/year (slope ± standard error). Some variables were related to both the 12-month GFR (intercept) and the slope: recipient gender, hepatitis C virus (HCV) status, estimated GFR (eGFR) at 3 months and proteinuria at 12 months. Some variables were only related to the slope of eGFR: time on dialysis, primary renal disease and immunosuppression. Others affected only the 12-month GFR: donor age, delayed graft function, acute rejection and systolic blood pressure at 12 months. Higher graft function at 3 months had a negative impact on the GFR slope. Cyclosporine-based immunosuppression had a less favourable effect on the rates of change in allograft function.Conclusions. There was a slow decline in GFR. Poor graft function was not associated with an increased rate of decline of allograft function. Immunosuppression with cyclosporine displayed the worst declining GFR rate.

Chronic Allograft Dysfunction in Kidney Transplant Recipients: Long-term Single-center Study

“…Grinyo et al analyzed the results of 872 renal transplant recipients with functioning graft at least 2 years after transplantation and found chronic allograft nephropathy (according to laboratory criteria: creatinine level >2 mg/dL and eGFR <50 mL/min) in 55.5% of patients after approximately 8 years from the time of renal transplantation [8]. The study of Marcén et al found CAD in 62.5% of patients 12 months after transplantation based on eGFR <59 mL/min [9]. In our study, diagnosis of CAD was based on increased of serum creatinine >2 m/dL, decreasing eGFR <50 mL/min, proteinuria, and poor control of arterial hypertension.…”

Reducing the Severity of Renal Graft Ischemic and Reperfusion Injury With Coupled Plasma Filtration and Adsorption

“…На большом клиническом материале доказано, что некоторые параметры могут служить прогнос-тическими критериями долгосрочной выживае-мости трансплантата [5][6][7][8][9][10][11][12][13], причем площадь под ROC-кривой достигает 0,86, что указывает на до-статочную прогностическую ценность этих пока-зателей. Большинство авторов сходятся во мнении, что в качестве таких критериев могут быть исполь-зованы такие простые, и что важно -неинвазивные методы, как измерение СКФ, концентрации креати-нина и суточной протеинурии.…”

Monitoring and Managing Graft Health in the Kidney Transplant Recipient

“…With this in mind, let us put into context the creatinine measurement and kidney function after transplantation. Whether 1, 5, or 10 years after transplantation, the GFR based on serum creatinine places the majority of patients into the stage 3T CKD (41). As seen in Figure 3, kidney function is reasonably stable over time with a slight trend toward a decrease over years as indicated by the slight shift to the left (42).…”