Factors affecting eGFR 5-year post-deceased donor renal transplant: analysis and predictive model

Abstract

Aim: Long-term survival of renal allografts has improved over the last 20 years. However, less is known about current expectations for long-term allograft function as determined by estimated glomerular filtration rate (eGFR). The aim of this study was to investigate factors which affect graft function at 5 years' post-renal transplantation. The statistically significant factors were then used to construct a predictive model for expected eGFR at five years' post-transplant. Methods: We retrospectively reviewed all adult patients who received a renal transplant in the Republic of Ireland between 1990 and. Data collected included era of transplantation (1990-1994, 1995-1999, 2000-2004), donor and recipient age and gender, number of human leucocyte antigen mismatches, cold ischemia time (CIT), number of prior renal transplants, immunosuppressive regimen used and acute rejection episodes. Estimated GFR was calculated at 5 years after transplantation from patient data using the Modified Diet in Renal Disease (MDRD) equation. Consecutive sampling was used to divide the study population into two equal unbiased groups of 489 patients. The first group (derivation cohort) was used to construct a predictive model for eGFR five years' post-transplantation, the second (validation cohort) to test this model. Results: Nine hundred and seventy eight patients were analyzed. The median age at transplantation was 43 years (range 18-78) and 620 (63.4%) were male. One hundred and seventy five patients (17.9%) had received a prior renal transplant. Improved eGFR at five years' post-transplantation was associated with tacrolimus-based combination immunosuppression, younger donor age, male recipient, absence of cytomegalovirus disease and absence of acute rejection episodes as independently significant factors (p50.05). The predictive model developed using these factors showed good correlation between predicted and actual median eGFR at five years. The model explained 20% of eGFR variability. The validation model findings were consistent with the derivation model (21% variability of eGFR explained by model using same covariates on new data). Conclusion: The predictive model we have developed shows good correlation between predicted and actual median eGFR at five years' post-transplant. Applications of this model include comparison of current and future therapy options such as new immunosuppressive regimens.

Ultrasound elastography correlations between anthropometrical parameters in kidney transplant recipients

“…Interestingly, Elbadri et al study have identified advanced donor age to be associated with low eGFR 5 years postrenal transplantation and advanced donor age to be a risk factor for delayed graft function (DGF), which is an independent predictor of late graft outcome and graft failure 14. We were also able to demonstrate that donor age to correlate with eGFR in our study in the patients group with transplantation >5 years (r=−0.4), but we did not experience higher USE stiffness results in Tx>5 years group with higher donor age (r=−0.3) 13.…”

Renal Allograft Rejection: Noninvasive Ultrasound- and MRI-Based Diagnostics

“…Ongoing progress in transplantation medicine results in better success rates of organ transplantation and a prolongation of renal allografts' half-life. [3, 4] Despite the considerable progress of immunosuppressive regimens, acute rejection (AR) still remains a serious issue after KTx, which decreases patient and graft survival rates after its occurrence [5, 6].…”

Predictors of Mid-Term Glomerular Filtration Rate after Deceased Donor Renal Transplantation: Kidney Donor Profile Index as a Predictor of Mid-Term GFR

“…These findings support our results. However, their overall donor age was much younger than our cohort (mean 36, range 21-47) and, they did not include HCV positive donors in their review [13].…”