Clinical Science
Long-Term Deterioration of Kidney Allograft Function

https://doi.org/10.1111/j.1600-6143.2005.00853.xGet rights and content
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Although long-term survival after kidney transplanta-tion is critically dependent on maintaining stable al-lograft function, few studies have examined renal al-lograft function over time. Using pooled data from 10 278 consecutive transplants at five centers, we cal-culated slopes of estimated glomerular filtration rates (eGFR) measured after 1, 6 and 12 months in 9515, 8861 and 7359 patients surviving ≥1, ≥6 and ≥12 months, respectively. Slopes of eGFR progressively di-minished for patients transplanted during 1984–1989, 1990–1993,1994–1998 and 1999–2002 (analysis of vari-ance p < 0.0001 and p = 0.1245 for slopes measured after 1 and 6 months, respectively). Slopes measured after 12 months were less in the most recent era: –2.2 ± 7.2 mL/min/1.73 m2/year, –2.3 ± 6.6 mL/min/1.73 m2/year, –2.4 ± 7.4 mL/min/1.73 m2/year and –1.4 ± 10.9 mL/min/1.73 m2/year, respectively, p = 0.0058. Slopes measured after 1, 6 and 12 months each were less for transplantations during 1999–2002, after adjusting for multiple transplantation characteristics (p < 0.0001). Similarly, in Cox proportional hazards analysis, the risk (95% CI) for a 25% reduction in eGFR was 0.92 (0.85–1.01), p = 0.0736 during 1990–1994; 0.94 (0.82–1.08), p = 0.4111 during 19951998 and 0.78 (0.64–0.95), p = 0.0110 during 1999–2002 (compared to 1984–1989). We conclude that the rate of decline in allograft function after kidney transplantation has improved, suggesting that stable, long-term function may be achievable.

Key words:

Glomerular filtration rate
graft rejection
graft survival
kidney transplantation
serum creatinine

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