Collaboration between local nephrologists and the transplant centre ensures good outcomes in post-transplant care

Abstract

Background Despite substantial improvements in short-term kidney allograft survival, median long-term survival remains at a standstill. It is unclear whether and to what extent a transplant-center's post-transplant care influences long-term outcomes. Methods We retrospectively analyzed 501 single kidney transplant recipients (KTRs) who underwent transplantation between 2 009 and 2 018 and did not develop rejection or dnDSA within the first post-transplant year. After that, KTRs were either followed exclusively three-monthly by the transplant-center(n = 197) or three-monthly by local nephrologists (n = 304) with only yearly follow-up by the transplant-center. We analyzed kidney allograft outcomes regarding eGFR decline, proteinuria, development of dnDSA, and rejection. Results No differences between the two groups were observed in the baseline characteristics and the characteristics at the end of the first post-transplant (p > 0.05). KTRs followed by local nephrologists were comparable to KTRs followed by the transplant-center concerning patient survival (p = 0.541), kidney allograft survival (p = 0.385), eGFR decline (p = 0.488), progression of proteinuria (p > 0.05), the development of dnDSA (p = 0.335), and TCMR (p = 0.480). KTRs followed by the transplant-center were more likely to undergo indication biopsies in case of allograft dysfunction and dnDSA (p < 0.001). ABMR was diagnosed earlier and more frequently (p = 0.059), recurrent glomerulonephritis was diagnosed earlier and more frequently (p = 0.026), and immunosuppression was modified earlier and more frequently in response to histological findings (p = 0.038). Conclusions Our findings suggest that close collaboration between local nephrologists and the transplant-center ensures good allograft outcomes independent of the caregiver. Higher biopsy activity in the transplant-center allows for earlier diagnosis of allograft dysfunction as the basis for novel treatment options.

Association between Kidney Donor Risk Index, kidney graft function and histological changes in early post-transplant graft biopsy

“…Kidney transplantation is the optimal treatment for patients with end-stage renal disease [ 1 ] and post-transplant care ensures optimal patient and graft survival [ 2 ]. However, due to the permanent organ shortage a substantial proportion of organs is procured from extended criteria donors (ECD) [ 3 ].…”