Introduction: Death with function (DWF) is a major cause of kidney allograft failure. However, few studies have examined the relationship between kidney allograft function and DWF. The aim of this study was to examine the role of graft function in DWF in more detail, including histologic analyses.
Methods: We retrospectively analyzed 1842 conventional kidney allografts transplanted at our center between 1/1/96 and 12/31/10. Glomerular filtration rate (eGFR) was estimated using the MDRD equation. eGFR within six months of DWF or at last follow-up in surviving recipients with functioning grafts was identified. Proportional hazards models were used to examine the relationship between eGFR and DWF. Allograft biopsies 1 year post-transplant and within 1 year of DWF or last follow-up were also reviewed.
Results: During 68 ± 43 months of follow-up, 13% (n=283) of recipients experienced DWF. Mean time to DWF was 58 ± 49 months. Multivariate analysis showed DWF was more common with increasing recipient age (HR=2.07, CI 1.77-2.43, p<0.0001), diabetes (HR=2.58, CI 1.81-3.69, p<0.0001), prior dialysis (HR=1.47, CI 1.05-2.06, p=0.03) and cause of ESRD (HR=1.65, CI 1.01-2.69, p=0.04). eGFR < 40 ml/min/1.73 m2 also was a risk factor for DWF, increasing the risk of death 2.26x for every 10 ml/min/1.73 m2 decrease in eGFR (p=0.0001).
Despite this relationship, only 20% (36/182) of patients had an eGFR ≤ 30 ml/min/1.73 m2 in the 6 months prior to DWF, and the mean eGFR prior to DWF was 50 ± 22 ml/min/1.73 m2. Histologic analyses showed no significant difference in allograft pathology 1 year post-transplant in DWF recipients compared to surviving recipients with functioning grafts. The majority of biopsies performed within 1 year of DWF (68%) demonstrated benign histology.
Conclusion: While a low eGFR is an independent risk factor for DWF, very few patients die with poor allograft function. It is unclear if an increase in eGFR would decrease DWF in the subset of patients with low eGFR given that most patients with DWF have good eGFR. It is unlikely that efforts to improve eGFR would have a major impact on overall rates of DWF.
To cite this abstract in AMA style:Lorenz E, El-Zoghby Z, Amer H, Dean P, Kremers W, Stegall M, Cosio F. Kidney Allograft Function and Histology in Recipients Dying with a Functioning Graft [abstract]. Am J Transplant. 2013; 13 (suppl 5). http://atcmeetingabstracts.com/abstract/kidney-allograft-function-and-histology-in-recipients-dying-with-a-functioning-graft/. Accessed January 16, 2018.
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