Kidney Week

Abstract: TH-PO775

Death and Kidney Failure in 3-Year Survivors of Kidney Transplantation: Influence of Prior Changes in eGFR

Session Information

• Transplantation: Clinical - 1
  October 24, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Transplantation

• 2102 Transplantation: Clinical

Authors

• McCausland, Finnian R., Brigham and Women's Hospital, Boston, Massachusetts, United States

Finnian R. McCausland, MBChB, MS, FASN

• McGrath, Martina M., Brigham and Women's Hospital, Boston, Massachusetts, United States

Martina M. McGrath, MD, MBChB, FASN

• Claggett, Brian, Brigham and Women's Hospital, Boston, Massachusetts, United States

Brian Claggett, MS, PhD

• Milford, Edgar L., Brigham and Women's Hospital, Boston, Massachusetts, United States

Edgar L. Milford, MD

• Levey, Andrew S., Tufts Medical Center, Boston, Massachusetts, United States

Andrew S. Levey, MD

• Pfeffer, Marc A., Brigham and Women's Hospital, Boston, Massachusetts, United States

Marc A. Pfeffer, MD, PhD

Background

Kidney transplant recipients (KTRs) continue to experience high rates of allograft failure and death. We explored if changes in eGFR between the first and third year post-transplant could identify patients at higher risk for subsequent allograft failure and death.

Methods

From 149,058 adult KTRs in the UNOS database who received a first kidney transplant from 2009-2019, we included 109,198 who survived to 3 years post-transplant with a functioning allograft and available baseline and follow-up (1- and 3-year post-transplant) serum creatinine. We calculated eGFR using the 2021 CKD-EPI equation and used Cox models, landmarked at 3-year post-transplant, to explore the association of eGFR decline (<0, 0-<5, and ≥5 mL/min/1.73m²/year) with subsequent development of the composite of allograft failure or death (median follow-up 3.5 yrs). Models were adjusted for age, sex, race, diabetes, BMI, baseline eGFR, graft vintage, and donor status (living/cadaveric).

Results

During the two-year exposure period, 50,796 (44%), 33,611 (31%), and 24,791 (23%) experienced eGFR decline <0, 0-<5, and ≥5 mL/min/1.73m²/year, respectively. Patients in the highest category of eGFR decline were more likely to be younger, female, Black, diabetic, received a cadaveric donor, have lower BMI, yet higher baseline eGFR. Overall, beginning 3 years post-transplant, 31,302 (23%) of patients developed allograft failure or death. Compared with eGFR decline <0, patients experiencing an annual decline >5 mL/min/1.73m² had a 2.6-fold (HR 2.62; 95%CI 2.55, 2.70) higher adjusted risk of allograft failure or death (Table 1).

Conclusion

In a contemporary cohort of KTRs, who survived at least 3 years post-transplant, rates of subsequent allograft failure and death remain unacceptably high. An eGFR decline >5 mL/min/1.73m²/year in the prior two years is an easily calculable metric and identifies patients at markedly higher risk of future allograft failure and death.