Recipients of Kidneys from Expanded Criteria Donors Whose eGFR Does not Drop >30% Between 1-12 Months after Transplantation Have Excellent Long-Term Graft Survival

Abstract

Purpose: To determine the impact of eGFR drop lower or greater than 30% during the first yr post-kidney transplantation (KTx) on long-term death censored graft survival (DCGS). Methods: We studied 471 KTx recipients of deceased donor kidneys between 1/1990 and 12/2006. 253 pts (53.7%, 82 women, 171 men, 49±12 yrs) received standard criteria donor (SCD) kidneys, and 218 pts (46.3%, 73 women, 145 men, 52±13 yrs) received ECD kidneys. Immunosuppression consisted of ATG induction, CNI and an antimetabolite. CIT was 15.4±8.4 hr. We analyzed an eGFR drop lower or greater than 30% between 1-3, 1-12 and 3-12 months in recipients of SCD and ECD kidneys, with immediate (IGF, Scr decreased ≥20% within 24 hrs post-KTx), slow (SGF, Scr decreased < 20% within 24 hrs post-KTx and no need for dialysis) or delayed graft function (DGF, need for dialysis during the first week post-KTx), on long-term DCGS in pts whose graft survived >1 yr post-KTx. 55 recipients of SCD and 34 recipients of ECD were excluded because of graft loss, death or loss to follow-up during the first yr. Results: The impact of eGFR drop on long-term DCGS is depicted in Figures 1 and 2. There was no difference in pts with SGF. eGFR (mL/min/1.73m2) at 1, 5 and 10 yrs was 71±22, 66±22 and 57±22 respectively, in recipients of SCD and 56±18, 49±23 and 41±20 respectively, in recipients of ECD (P=0.001). An eGFR drop between 1-12 months was associated with lower DCGS (HR 2.16, P=0.02).Figure: [*P=0.002 and **P=0.01 vs. ECD Drop >30%]Figure: [P<0.0001 and **P=0.0003 vs. ECD Drop >30%]Conclusion: Recipients of ECD kidneys without an eGFR drop >30% between 1-12 months post-KTx have excellent long-term DCGS, equivalent to recipients of SCD kidneys.