Renal function following living, standard criteria deceased and expanded criteria deceased donor kidney transplantation: impact on graft failure and death

Abstract

We examined United States Renal Data System (USRDS) data for adult kidney transplant recipients in 1995-2003 (n = 87 575) to investigate associations of 12-month renal function with long-term clinical outcomes. Estimated glomerular filtration rate (eGFR) was computed by the Modification of Diet in Renal Disease (MDRD) equation. Associations of eGFR at the first transplant anniversary with graft and patient-survival in years 1-9 post-transplant were evaluated by multivariate nonlinear regression with spline forms, adjusted for recipient, donor, and transplant factors. Regardless of donor type, the likelihood of graft failure and death increased significantly with lower eGFR. The impact of poor eGFR was more pronounced for graft failure than death. Relative effects were similar across donor types, but were strongest among living-donor recipients. For example, compared with reference eGFR of 80 ml/min/1.73 m2, 1-year eGFR of 20 ml/min/1.73 m2 was associated with adjusted hazards ratios for subsequent death-censored graft failure of 9.2 in living, 8.9 in standard criteria deceased, and 5.9 in expanded criteria deceased-donor recipients. First-year renal function after kidney transplantation has strong, nonlinear associations with subsequent allograft and patient survival regardless of donor type. Post-transplant eGFR may be a useful end-point for discriminating benefits of care strategies that differentially affect renal function.