Examination of changes in kidney function after transplantation could help identify subgroups of patients who may benefit from a change in clinical management. In the last 10 years immunosuppression minimization strategies (i.e. steroid and CNI minimization and/or withdrawal) have become increasingly utilized in clinical transplantation, but the long term safety of these protocols remains uncertain.

In this study we examined secular changes in the annualized change in eGFR between the 1st and 3rd post transplant year (eGFR slope) in all n=113,089 adult kidney transplant recipients grouped by donor type using repeated measures linear regression with adjustment for the baseline level of eGFR at 1 year after transplantation.

During the study period the median annualized change in eGFR (slope) was -1.24 and -1.35 for living (n=47,577) and deceased donor transplant recipients (n=65,512). Figure A shows that eGFR loss was least in living donor recipients and highest in DCD recipients. The rate of eGFR loss improved and stabilized over time in recipients of all donor types.

Among NDD recipients, this improvement was consistent across the spectrum of kidney donor profile index (KDPI) (Figure B).

Given the increased medical complexity of transplant recipients during this time frame, the improvement in the stability of allograft function across all donor types validates current management strategies, while we await long term outcomes.

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