Background: The rate of decline in eGFR (slope) has been independently associated with a higher risk of cardiovascular events and all cause mortality in kidney transplant recipients, and may also predict patients at risk of early graft failure. The aim of this study is to investigate how eGFR slope correlates with donor type and its association with specific patient characteristics.

Methods:

Using data provided by the UK Renal Registry we analysed all patients aged ≥18 years who received a kidney transplant in the UK between 1st January 2007 and 31st December 2009. A mixed model for repeated measurements was used to calculate eGFR slopes, with examination of linear, quadratic and cubic regression models. This multivariable analysis adjusted for age, ethnicity, gender, primary renal diagnosis, social deprivation, time on dialysis and donor type. Patients were followed up to 4 years post transplant and required a minimum of 18 months graft function with three or more creatinine measurements for inclusion. P value of less than 0.05 was considered significant.

Results:

Of 5226 identified patients, 4829 (92.4% data completeness) were analysed in a fully adjusted multivariable model. The overall median eGFR at one year after transplantation was 55.3ml/min/1.73m². This compared to a median eGFR at one year of 57.6 ml/min/1.73m² for live kidney donors (LKD), 55ml/min/1.73m² for donation after brainstem death (DBD), and 51.3ml/min/1.73m² for donation after circulatory death (DCD). The overall unadjusted median eGFR decline was -1.01ml/min/1.73m²/year. Factors associated with a steeper decline included age <40 years (p<0.0001), female gender (p<0.0001), diabetes (p=0.0005), and increasing social deprivation (p=0.003). There were no significant differences between donor groups, except for younger DCD recipients (age <40years) who had a significantly better outcome (1.85, p=0.0006).

Conclusions:

Despite having a lower initial eGFR, rates of decline in DCD and DBD kidneys is comparable to LKD recipients up to 4 years after transplantation in the UK. Further research is needed to understand the lower rates of decline seen in younger DCD recipients, and the patient variables associated with steeper decline including younger age, social deprivation, female gender and diabetes.

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