Background: Improving long-term outcomes is an important but unmet need after kidney transplant. Protocol renal allograft biopsies taken 10-years after transplant frequently show diabetic nephropathy and vascular disease, thereby highlighting the importance of post-transplant metabolic parameters. The aim of this study was to determine the prevalence of metabolic complications, including hyperlipidemia, anemia and vitamin D deficiency, in patients with functioning allografts 10 years after kidney transplant.

Methods: A retrospective analysis of consecutive, adult solitary kidney transplants performed at the Mayo Clinic in Rochester, Minnesota, between 1/2002 and 1/2007 that were functioning 10 years after transplant was conducted (n=515). According to our clinical protocol, patients with functioning allografts are asked to undergo measurement of their lipids, hemoglobin and total 25-hydroxy vitamin D levels on an annual basis. Laboratory studies obtained 10-years post-transplant (± 6 months) were analyzed. Anemia was defined as a hemoglobin < 11.0 g/dL, hyperlipidemia as a LDL > 100 mg/dL and vitamin D deficiency as a total 25-hydroxy vitamin D level < 30 ng/mL.

Results: Mean age at time of transplant was 50 ± 13 years, 56% of patients were male, 83% received transplants from living donors, 91% were Caucasian and 95% were maintained on tacrolimus-based immunosuppression. At 10-years post-transplantation, mean eGFR was 50.3 ± 19.5 ml/min/1.73 m². Overall, 26% of patients had hyperlipidemia, 24% were anemic and 23% had vitamin D deficiency. On multivariate analysis, age was associated with hyperlipidemia (OR 0.72 per 10 year increase, CI 0.60-0.87, p=0.0006). In contrast, female gender and eGFR were associated with anemia (OR 1.85, CI 1.13-3.05, p=0.01 and OR 0.45 per 10 ml/min/1.73 m2 increase, CI 0.37-0.54, p<0.0001, respectively). Overall, 25% of patients did not have a LDL available for review, 10% did not have a hemoglobin available for review and 33% did not have a total 25-hydroxy vitamin D level available for review.

Discussion: Metabolic complications are common 10 years after kidney transplant and are likely frequently overlooked by transplant centers due to incomplete laboratory monitoring. These metabolic complications, including hyperlipidemia, anemia and vitamin D deficiency, may contribute to decreased quality of life and increased risk of mortality. More attention needs to be paid to long-term follow-up after kidney transplant and the impact and treatment of late metabolic complications.

CITATION INFORMATION: Lorenz E., Cosio F., Stegall M. Metabolic Complications 10-Years after Kidney Transplant Am J Transplant. 2017;17 (suppl 3).

« Back to 2018 American Transplant Congress