Kidney Week

Abstract: PO2431

Association of the Rate of Kidney Transplant Function Decline with the Risk of Death After Graft Loss

Session Information

• Clinical and Immunologic Predictors of Post-Transplant Outcomes
  October 22, 2020 | Location: On-Demand
  Abstract Time: 10:00 AM - 12:00 PM

Category: Transplantation

• 1902 Transplantation: Clinical

Authors

• Ramos, Everly, Vanderbilt University Medical Center, Nashville, Tennessee, United States

Everly Ramos,

• Binari, Laura, Vanderbilt University Medical Center, Nashville, Tennessee, United States

Laura Binari,

• Thorne, Peter E., Vanderbilt University Medical Center, Nashville, Tennessee, United States

Peter E. Thorne,

• Kochar, Guneet S., Vanderbilt University Medical Center, Nashville, Tennessee, United States

Guneet S. Kochar,

• Shawar, Saed, Vanderbilt University Medical Center, Nashville, Tennessee, United States

Saed Shawar,

• Stewart, Thomas G., Vanderbilt University Medical Center, Nashville, Tennessee, United States

Thomas G. Stewart,

• Prigmore, Heather Leanne, Vanderbilt University Medical Center, Nashville, Tennessee, United States

Heather Leanne Prigmore,

• Forbes, Rachel C., Vanderbilt University Medical Center, Nashville, Tennessee, United States

Rachel C. Forbes,

• Abdel-Kader, Khaled, Vanderbilt University Medical Center, Nashville, Tennessee, United States

Khaled Abdel-Kader,

• Concepcion, Beatrice P., Vanderbilt University Medical Center, Nashville, Tennessee, United States

Beatrice P. Concepcion,

Background

Patients with failed kidney transplants are at increased risk of death after graft loss compared to transplant-naïve counterparts. We hypothesized that in this high risk population, a faster decline in eGFR in the 2y prior to graft loss is associated with death after graft loss.

Methods

We retrospectively reviewed all patients with death censored graft loss (DCGL) from 1995-2018 at a single center. We collected demographic, clinical and transplant characteristics at time of transplant and graft loss. Rate of eGFR decline was expressed as eGFR slope, calculated from all SCr values obtained within 2y prior to graft loss. Cox proportional hazards regression was used to determine the association between rate of eGFR decline and death while adjusting for age, gender, race, cause of ESKD, cause of graft loss, dialysis access at graft loss, and nephrectomy after graft loss.

Results

333 patients with DCGL were included. Baseline characteristics were: median age 45y (IQR 35,57), 59% male, 43% black; 19% DM as cause of ESKD. CAN (65%) and acute rejection (29%) were the top causes of graft loss at a median time from transplant of 4.9y (IQR 2.5,7.9). Rate of eGFR decline (in ml/min/1.73m²/y) was -14.49 ± 13.24 (mean±SD) and -11.73 (-18.72,-6.19) (median,IQR). At time of DCGL, 46% had a history of acute rejection and 34% had a permanent dialysis access. Of the 251 patients without missing data, 97 (40%) died and 68 (27%) underwent a nephrectomy after graft loss. Median time from graft loss to death was 3.1y (IQR 1.4,7.3). In multivariable analysis, there was a 0.6% increase risk in death for every 1 ml/min/1.73m²/y increase in rate of eGFR decline though not statistically significant (HR 1.006, 95% CI 1.00-1.01). Exploratory analysis with non-linear modeling of eGFR slope showed that the risk of death increases up to a rate of decline of 10 ml/min/1.73m²/y. DM as cause of ESKD was associated with an almost 2-fold increase in risk of death after graft loss compared to non-DM (HR 1.95, 95% CI 1.27-2.96).

Conclusion

In this single-center cohort of kidney transplant recipients with DCGL, a faster rate of eGFR decline in the 2y prior to graft loss was not associated with a higher risk of death after graft loss after adjustment for important clinical variables.