Slope of changes in renal function in the first year post-transplantation and one-yr estimated glomerular filtration rate together predict long-term renal allograft survival.

BACKGROUND: Few studies have examined the predictive value of the slope of changes in renal function in the first year post-transplantation when combined with one-yr estimated glomerular filtration rate (eGFR).
METHODS: We reviewed 1062 recipients who underwent renal transplantations from deceased donors between January 1992 and June 2003. Recipients were stratified into four groups: (a) one-yr eGFR < 45 mL/min and slope <-2 mL/min/month, (b) one-yr eGFR < 45 mL/min and slope >-2 mL/min/month, (c) one-yr eGFR > 45 mL/min and slope <-2 mL/min/month, and (d) one-yr eGFR > 45 mL/min and slope > -2 mL/min/month. Survival was assessed by Kaplan-Meier analysis and the significance of variables with the Cox proportional hazard model.
RESULTS: Both the slopes of eGFR changes and one-yr eGFR were significantly associated with survival in univariate analysis. The hazard ratio of graft loss was 2.645 when one-yr eGFR was < 45 mL/min. The risk increased to 7.438 when this was combined with slope < -2 mL/min/month. Patients with one-yr eGFR < 45 mL/min and slope >-2 mL/min/month had five- and 10-yr graft survival rates similar to those with one-yr eGFR >45 mL/min.
CONCLUSIONS: Long-term graft survival was related to one-yr eGFR and the slope of changes in eGFR within the first year. Their combination provides a more discriminatory predictive value.