Premium
Late graft failure after kidney transplantation as the consequence of late versus early events
Author(s) -
Gaston Robert S.,
Fieberg Ann,
Hunsicker Lawrence,
Kasiske Bertram L.,
Leduc Robert,
Cosio Fernando G.,
Gourishankar Sita,
Grande Joseph,
Man Roslyn B.,
Rush David,
Cecka J. Michael,
Connett John,
Matas Arthur J.
Publication year - 2018
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/ajt.14590
Subject(s) - medicine , creatinine , renal function , kidney , prospective cohort study , proteinuria , transplantation , kidney transplantation , biopsy , urology , cohort , surgery , gastroenterology
Beyond the first posttransplant year, 3% of kidney transplants fail annually. In a prospective, multicenter cohort study, we tested the relative impact of early versus late events on risk of long‐term death‐censored graft failure ( DCGF ). In grafts surviving at least 90 days, early events (acute rejection [ AR ] and delayed graft function [ DGF ] before day 90) were recorded; serum creatinine (Cr) at day 90 was defined as baseline. Thereafter, a 25% rise in serum Cr or new‐onset proteinuria triggered graft biopsy (index biopsy, IB x), allowing comparison of risk of DCGF associated with early events ( AR , DGF , baseline serum Cr >2.0 mg/ dL ) to that associated with later events ( IB x). Among 3678 patients followed for 4.7 ± 1.9 years, 753 (20%) had IB x at a median of 15.3 months posttransplant. Early AR ( HR = 1.77, P < .001) and elevated Cr at Day 90 ( HR = 2.56, P < .0001) were associated with increased risk of DCGF ; however, later‐onset dysfunction requiring IB x had far greater impact ( HR = 13.8, P < .0001). At 90 days, neither clinical characteristics nor early events distinguished those who subsequently did or did not undergo IB x or suffer DCGF . To improve long‐term kidney allograft survival, management paradigms should promote prompt diagnosis and treatment of both early and later events.