ASN's Mission

ASN leads the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on Twitter

Kidney Week

Abstract: PO2423

Short-Term Variability in Graft Function Is Associated with Long-Term Mortality but Not Allograft Survival in Kidney Transplant Recipients

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Lyu, Beini, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, United States
  • Mandelbrot, Didier A., University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, United States
  • Djamali, Arjang, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, United States
  • Astor, Brad C., University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, United States
Background

It is critical to identify kidney transplant recipients (KTR) at highest risk of graft failure and death to focus on monitoring and interventions to improve long-term outcomes. Variability in native kidney function is associated with the risk of mortality and hospitalization in chronic kidney disease, but it remains uncertain whether such associations exist in KTR. We examined the hypothesis that short-term graft function variability is associated with long-term outcomes in KTRs.

Methods

Using the Wisconsin Allograft Recipient Database (WisARD), we identified 2919 KTRs who had a functioning allograft at least 2 years after transplantation and at least 3 outpatient estimated glomerular filtration rate (eGFR) measurements from 1 to 2 years post-transplant. Graft function variability was defined for each patient as the coefficient of variation based on a linear regression of eGFR from 1 to 2 years. Associations between eGFR variability and total graft loss, death and graft failure were estimated in competing risk models

Results

Patients with greater variability were more likely to be female, have more comorbidities, and have more prior hospitalization events at baseline. Compared to the lowest quartile, the highest quartile of eGFR variability was associated with a higher risk of total graft loss (adjusted HR 1.51, 95% CI: 1.11-2.06) and a higher risk of death (adjusted HR 1.85, 95% CI: 1.23-2.76), but not with a higher risk of graft failure (subHR 1.08, 95% CI: 0.64-1.83 in competing risk analysis), independent of eGFR and slope of eGFR. The associations remained consistent across strata of acute rejection, diabetes, peripheral arterial disease, baseline eGFR, history of cardiovascular disease, baseline hospitalization, and with all variability indicators and modeling approaches.

Conclusion

Short-term eGFR variability is associated with long-term death but not graft failure. Variability in eGFR provides independent prognostic information on transplantation outcomes and may be an indicator to differentiate the risk of death and graft failure.