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

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). 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. 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. 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.