Abstract
BackgroundProteinuria after kidney transplantation portends a worse graft survival. However the magnitude of proteinuria related to patient and graft survival and its correlation with donor and recipient characteristics are poorly explored.MethodsThis study investigated the impact of post transplant proteinuria in the first year in 1127 kidney transplants analyzing the impact of different donor ages. Proteinuria cut off was set at 0.5 g/day.ResultsTransplants with proteinuria > 0.5 g/day correlated with poor graft and patient outcome in all donor age groups. In addition, 6-month-1-year proteinuria increase was significantly associated with graft outcome, especially with donors > 60 years old (p < 0.05; Odd Ratio 1.8). 1-year graft function (eGFR < or ≥ 44 ml/min) had similar impact to proteinuria (≥ 0.5 g/day) on graft failure (Hazard Ratio 2.77 vs Hazard Ratio 2.46). Low-grade proteinuria (0.2–0.5 g/day) demonstrated a trend for worse graft survival with increasing donor age. Also in kidney-paired analysis proteinuria ≥0.5 effect was more significant with donors > 50 years old (Odd Ratio 2.3).ConclusionsPost-transplant proteinuria was increasingly harmful with older donor age. Proteinuria ≥0.5 g/day correlates with worse outcomes in all transplanted patients. Prognostic value of proteinuria and eGFR for graft and patient survival was comparable and these two variables remain significant risk factors even in a multivariate model that take into consideration the most important clinical variables (donor age, rejection, delayed graft function and cytomegalovirus viremia among others).
Highlights
Proteinuria after kidney transplantation portends a worse graft survival
Assuming 0.5 g/day as proteinuria cut-off, the association of 1-year PTO with death censored graft survival (DCGS) and graft survival was present for all donor age classes (Table 2); the impact of proteinuria on patient survival was noted only for younger donors
Donor age increased the magnitude of proteinuria impact: DCGS of patients with donor age ≥ 70 years and higher 1-year proteinuria was only 29.7% versus 72.3% in recipients of kidneys from younger donors with the same proteinuria (p = 0.03)
Summary
Proteinuria after kidney transplantation portends a worse graft survival. the magnitude of proteinuria related to patient and graft survival and its correlation with donor and recipient characteristics are poorly explored. Increase of donor pool by using elderly donors has been largely adopted to reduce kidney transplant (KT) waiting list [1]. Proteinuria is known to be an independent risk factor for cardiovascular disease and mortality in native kidneys as well as an indicator of renal damage and a predictor of allograft loss after kidney transplantation [5, 6]. Even if older donor age is mentioned as risk factor for development of post-KT proteinuria [8, 13], the effective impact of proteinuria in recipients of elderly donors is not clearly defined and studied. Halimi and coworkers showed a strong correlation of 1- and 3-month proteinuria (per every 0.1 g/day increase) with graft loss [7]. Amer and colleagues analyzed 1-year post KT proteinuria finding an Hazard Ratio (HR) for graft loss of 2.15 (CI 95% 0.68–6.8), associated with proteinuria between 150 and 500 mg/day and an HR of 5.11 (CI 95% 1.4–19.2) with higher level of proteinuria [9]
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