High eGFR Associated with Worse Long-Term Graft Survival

American Transplant Congress 2020

Cardiovascular morbidity and mortality is associated with high estimated glomerular filtration rate (eGFR) as well as low eGFR. In recipients of kidney transplantation, the transplanted kidney is exposed to hyperfiltration-mediated injury. Those nonimmunological injuries, as well as immunological injuries, further accelerate poor graft outcome in transplant recipients.

H. Choi and colleagues in Korea conducted a study to examine whether high levels of eGFR at post-transplantation in the first year are a risk factor for long-term graft survival in kidney transplantation patients. Results of the study were reported during a virtual poster session at the American Transplant Congress 2020 in a poster titled High Estimated Glomerular Filtration Rate in the First Year after Kidney Transplantation Is Associated with Worse Long-Term Graft Survival in Kidney Recipients.

The single-center study included 1692 adult kidney transplant recipients with more than 1 year of follow-up. Serum creatinine level was measured throughout the study period. Cox regression model covariates included duration of dialysis prior to transplantation, recipient age and sex, related status, acute rejection status, diabetes status, and GFR at 1 year after kidney transplantation. Study participants were stratified into four groups according to GFR level: (1) 60 to 75 mL/min/1.73 m²; (2) 76 to 90 mL/min/1.73 m²; (3) 91 to 105 mL/min/1.73 m²; and (4) 106 to maximum mL/min/1.73 m². Participants with eGFR <60 mL/min/1.73 m² were excluded.

The rate of graft survival, as estimated by the Kaplan-Meier estimator, was significantly lower in participants in the eGFR 106 to maximum mL/min/1.73 m² category (log-rank test P=.016). In multivariable Cox regression models, following adjustment for recipient age and sex, related status, acute rejection status, and diabetes status, there was a significant association between the highest eGFR group and higher graft failure (hazard ratio, 1.629; P=.014).

“Our data support that the higher eGFR at 1 year after kidney transplantation is associated with poor outcome for long-term kidney graft survival in kidney transplant recipients,” the researchers said.

Source: Choi H, Huh K, Kim M, Kim S, Kim Y, Kim B. High estimated glomerular filtration rate at the first year after kidney transplantation is associated with worse long-term graft survival in kidney recipients. Abstract of a poster presented at the virtual American Transplant Congress (Abstract C-066), May 30, 2020.