Abstract
Reduced estimated glomerular filtration rate (eGFR) at 12-months after kidney transplantation is associated with increased risk of allograft loss, but it is uncertain whether donor age and types modify this relationship. Using Australia and New Zealand registry data, multivariable Cox proportional modelling was used to examine the interactive effects between donor age, types and 12-month eGFR on overall allograft loss. We included 11,095 recipients (4,423 received live-donors). Recipients with lowest 12-month eGFR (<30 ml/min/1.73 m2) experienced the greatest risk of allograft loss, with adjusted HR [95% CI) of 2.65 [2.38–2.95] compared to eGFR of 30–60 ml/min/1.73 m 2 ; whereas the adjusted HR for highest eGFR (>60 ml/min/1.73 m2) was 0.67 [0.62–0.74]. The association of 12-month eGFR and allograft loss was modified by donor age (but not donor types) where a higher risk of allograft loss in recipients with lower compared with higher 12-month eGFR being most pronounced in the younger donor age groups (p < 0.01). Recipients with eGFR <30 ml/min/1.73 m2 12-months after transplantation experienced ≥2.5-fold increased risk of overall allograft loss compared to those with eGFR of >60 ml/min/1.73 m2, and the magnitude of the increased risk is most marked among recipients with younger donors. Careful deliberation of other factors including donor age when considering eGFR as a surrogate for clinical endpoints is warranted.
Highlights
Reduced estimated glomerular filtration rate is associated with an increased risk of all-cause and cardiovascular mortality in the general population and people with chronic kidney disease [1,2,3,4]
Our study findings suggest that the effects of reduced short-term allograft function at 12-month on longer term allograft outcome differs in recipients of younger and older donor kidneys, with the magnitude of the risk for overall allograft loss being higher for recipients of younger donor kidneys with lower 12-month estimated glomerular filtration rate (eGFR) values than those who received older donor kidneys
Our current findings may imply that clinical events or disease phenotypes that may have led to a reduced eGFR at 12-months for recipients with younger donor kidneys are different from recipients of older donor kidneys who had reduced eGFR at 12-months
Summary
Reduced estimated glomerular filtration rate (eGFR) is associated with an increased risk of all-cause and cardiovascular mortality in the general population and people with chronic kidney disease [1,2,3,4]. The growing use of expanded criteria (or higher Kidney Donor Profile Index [KDPI]) donors has prompted clinicians to recognize that specific donor factors, including donor age and comorbidities, may influence short- and long-term outcomes after transplantation [16,17,18]. Many of these confounding factors have been adjusted for in the predictions for allograft loss and mortality. The aim of this study was to determine whether donor age and type modify the associations between 12-month allograft function and risk of longterm allograft and patient outcomes in a contemporary cohort of kidney transplant recipients
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