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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

Authors


Corresponding author: Jianghua Chen, MD, Kidney Disease Center, First Affiliated Hospital, Medical College of Zhejiang University, #79 Qingchun Rd., Hangzhou 310003, China.
Tel.: 86 57187236992; fax: 86 57187236992; e-mail: chenjianghua@zju.edu.cn.

Abstract

Wu J, Li H, Huang H, Wang R, Wang Y, He Q, Chen J. 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.
Clin Transplant 2010: 24: 862–868. © 2010 John Wiley & Sons A/S.

Abstract: Background:  Few studies have examined the predictive value of the slope of changes in renal function in the first year post-transplantation when combined with one-yr estimated glomerular filtration rate (eGFR).

Methods:  We reviewed 1062 recipients who underwent renal transplantations from deceased donors between January 1992 and June 2003. Recipients were stratified into four groups: (a) one-yr eGFR <45 mL/min and slope <−2 mL/min/month, (b) one-yr eGFR <45 mL/min and slope >−2 mL/min/month, (c) one-yr eGFR >45 mL/min and slope <−2 mL/min/month, and (d) one-yr eGFR >45 mL/min and slope >−2 mL/min/month. Survival was assessed by Kaplan-Meier analysis and the significance of variables with the Cox proportional hazard model.

Results:  Both the slopes of eGFR changes and one-yr eGFR were significantly associated with survival in univariate analysis. The hazard ratio of graft loss was 2.645 when one-yr eGFR was <45 mL/min. The risk increased to 7.438 when this was combined with slope <−2 mL/min/month. Patients with one-yr eGFR <45 mL/min and slope >−2 mL/min/month had five- and 10-yr graft survival rates similar to those with one-yr eGFR >45 mL/min.

Conclusions:  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.

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