BACKGROUND: Although chronic progressive renal transplant failure (CPTF) is one of the leading causes of end-stage renal disease its exact pathogenesis is still incompletely understood. Histopathological as well as clinical similarities between chronic native kidney diseases and CPTF open the possibility that the latter condition is not exclusively due to a prolonged immunological insult to the grafted organ but also is caused by a mismatch between the metabolic demands of the recipient and the excretory capacity of the transplanted kidney. In this retrospective study we defined clinical parameters which are associated with CPTF. METHODS: Creatinine clearance was followed in 469 patients 45 +/- 0.9 months after transplantation for 2 years. Various immunological and non-immunological parameters were included in an univariate and multivariate regression analysis to define those which are independently associated with CPTF, defined as a decrease of creatinine clearance during the study period. RESULTS: Of all the parameters proteinuria, systolic blood pressure, high Cyclosporin trough concentrations and the cumulative steroid dose were found to be significantly associated with CPTF. A persistent proteinuria of > 2 g/d during the observation period was found to have a positive predictive value of 83% for a deterioration of excretory kidney function of > or = 25% within 2 years. CONCLUSION: In CPTF immunological as well as non immunological factors are independently associated with the decline of excretory allograft function in the late postoperative period.
BACKGROUND: Although chronic progressive renal transplant failure (CPTF) is one of the leading causes of end-stage renal disease its exact pathogenesis is still incompletely understood. Histopathological as well as clinical similarities between chronic native kidney diseases and CPTF open the possibility that the latter condition is not exclusively due to a prolonged immunological insult to the grafted organ but also is caused by a mismatch between the metabolic demands of the recipient and the excretory capacity of the transplanted kidney. In this retrospective study we defined clinical parameters which are associated with CPTF. METHODS:Creatinine clearance was followed in 469 patients 45 +/- 0.9 months after transplantation for 2 years. Various immunological and non-immunological parameters were included in an univariate and multivariate regression analysis to define those which are independently associated with CPTF, defined as a decrease of creatinine clearance during the study period. RESULTS: Of all the parameters proteinuria, systolic blood pressure, high Cyclosporin trough concentrations and the cumulative steroid dose were found to be significantly associated with CPTF. A persistent proteinuria of > 2 g/d during the observation period was found to have a positive predictive value of 83% for a deterioration of excretory kidney function of > or = 25% within 2 years. CONCLUSION: In CPTF immunological as well as non immunological factors are independently associated with the decline of excretory allograft function in the late postoperative period.