Slope of changes in renal function in the first year post‐transplantation and one‐yr estimated glomerular filtration rate together predict long‐term renal allograft survival

Abstract

Long-term graft survival was related to one-yr eGFR and the slope of changes in eGFR within the first year. Their combination provides a more discriminatory predictive value.

Influence of renal function on long-term graft survival and patient survival in renal transplant recipients

“…Nine of these studies were categorized as large scale (!500 patients) 7,8,10,12,15,18,20,23,25 , and the 13 studies that performed significance testing on the link between GFR and death-censored graft loss reported a significant association between reduced GFR and an elevated risk for death-censored graft loss 7,8,10,12,15,[17][18][19][20]22,23,25,26 . As expected, the magnitude of the relationship between declining GFR and graft survival was increased when censored for death.…”

“…Of those studies assessing overall graft survival a total of eight were considered large scale studies with a sample size in excess of 500 patients 7,8,[10][11][12][13]15,16 . Additionally, a total of 5 out of the 11 studies that assessed overall graft survival were conducted exclusively in European populations 9,12,[15][16][17] .…”

“…The literature review identified a total of 11 studies that examined the relationship between GFR and overall graft survival [7][8][9][10][11][12][13][14][15][16][17] , and 17 studies examined death-censored graft survival 7,8,[10][11][12][15][16][17][18][19][20][21][22][23][24][25][26] . Four studies did not state whether graft survival was censored for death or not (Table 1) [27][28][29][30] .…”

Renal Function Variability: An Independent Risk Factor for Graft Loss and Death following Kidney Transplantation

“…Instead of looking at the last couple of serum creatinine or eGFR values during a post-transplant encounter, eGFR slope demonstrates what has been happening over a long period of time. Wu et al [12] performed a retrospective analysis of deceased donor recipients who underwent transplant between 1992 and 2003. Utilizing a slope generated from eGFR calculations from serum creatinine values obtained at month 1, 2, 3, 6, 12, and annually thereafter, authors were able to demonstrate that a slope of <-2 mL/min/month was predictive of poor long-term allograft outcomes (HR 1.683 with 95% CI 1.12-2.527) in univariate analysis, specifically when combined with 1 year GFR <45 mL/min [12].…”

“…Wu et al [12] performed a retrospective analysis of deceased donor recipients who underwent transplant between 1992 and 2003. Utilizing a slope generated from eGFR calculations from serum creatinine values obtained at month 1, 2, 3, 6, 12, and annually thereafter, authors were able to demonstrate that a slope of <-2 mL/min/month was predictive of poor long-term allograft outcomes (HR 1.683 with 95% CI 1.12-2.527) in univariate analysis, specifically when combined with 1 year GFR <45 mL/min [12]. Similar findings were also reported by Park et al [13] where they looked in change in eGFR between 3 and 12 months post-transplant and divided their cohort into 3 groups (≥10%, between -10 and 10%, <-10%) to evaluate long-term outcomes.…”