Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Mar 20;22(1):102.
doi: 10.1186/s12882-021-02285-2.

Early renal function trajectories, cytomegalovirus serostatus and long-term graft outcomes in kidney transplant recipients

Jonathan P Law  1   2 , Richard Borrows  2 , David McNulty  3 , Adnan Sharif  2 , Charles J Ferro  4   5
Affiliations

Early renal function trajectories, cytomegalovirus serostatus and long-term graft outcomes in kidney transplant recipients

Jonathan P Law et al. BMC Nephrol. .

Abstract

Background: Improved recognition of factors influencing graft survival has led to better short-term kidney transplant outcomes. However, efforts to prevent long-term graft decline and improve graft survival have seen more modest improvements. The adoption of electronic health records has enabled better recording and identification of donor-recipient factors through the use of modern statistical techniques. We have previously shown in a prevalent renal transplant population that episodes of rapid deterioration are associated with graft loss.

Methods: Estimated glomerular filtration rates (eGFR) between 3 and 27 months after transplantation were collected from 310 kidney transplant recipients. We utilised a Bayesian approach to estimate the most likely eGFR trajectory as a smooth curve from an average of 10,000 Monte Carlo samples. The probability of having an episode of rapid deterioration (decline greater than 5 ml/min/1.73 m2 per year in any 1-month period) was calculated. Graft loss and mortality data was collected over a median follow-up period of 8 years. Factors associated with having an episode of rapid deterioration and associations with long-term graft loss were explored.

Results: In multivariable Cox Proportional Hazard analysis, a probability greater than 0.8 of rapid deterioration was associated with long-term death-censored graft loss (Hazard ratio 2.17; 95% Confidence intervals [CI] 1.04-4.55). In separate multivariable logistic regression models, cytomegalovirus (CMV) serostatus donor positive to recipient positive (Odds ratio [OR] 3.82; 95%CI 1.63-8.97), CMV donor positive (OR 2.06; 95%CI 1.15-3.68), and CMV recipient positive (OR 2.03; 95%CI 1.14-3.60) were associated with having a greater than 0.8 probability of an episode of rapid deterioration.

Conclusions: Early episodes of rapid deterioration are associated with long-term death-censored graft loss and are associated with cytomegalovirus seropositivity. Further study is required to better manage these potentially modifiable risks factors and improve long-term graft survival.

Keywords: Allograft function; Bayesian; Cytomegalovirus serostatus; Estimated glomerular filtration rate; Kidney transplantation.

PubMed Disclaimer

Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
Flow diagram showing numbers and reasons for patients included and excluded in this study
Fig. 2
Fig. 2
a shows an average trajectory with probability close to 1 of rapid deterioration. b shows an average trajectory with probability close to 0 of rapid deterioration. The horizontal axis is months since transplantation and the vertical axis is estimated glomerular filtration rate (eGFR; ml/min/1.73 m2). (blue dots) eGFR data. (red smooth curve) The estimated trajectory
Fig. 3
Fig. 3
The distribution of probabilities of rapid deterioration visualised by percentage frequency histograms
Fig. 4
Fig. 4
Death-censored Kaplan-Meier graft survival analysis for patients with and without a ≥ 0.8 probability of an episode of rapid deterioration
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Lamb KE, Lodhi S, Meier-Kriesche HU. Long-term renal allograft survival in the United States: a critical reappraisal. Am J Transplant. 2011;11(3):450–462. doi: 10.1111/j.1600-6143.2010.03283.x. - DOI - PubMed
    1. Meier-Kriesche HU, Schold JD, Kaplan B. Long-term renal allograft survival: have we made significant progress or is it time to rethink our analytic and therapeutic strategies? Am J Transplant. 2004;4(8):1289–1295. doi: 10.1111/j.1600-6143.2004.00515.x. - DOI - PubMed
    1. U.S. Renal Data System . USRDS 2012 Annual Data Report: Atlas of End-Stage Renal Disease in the United States. Bethseda: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases; 2012.
    1. Howell M, Tong A, Wong G, Craig JC, Howard K. Important outcomes for kidney transplant recipients: a nominal group and qualitative study. Am J Kidney Dis. 2012;60(2):186–196. doi: 10.1053/j.ajkd.2012.02.339. - DOI - PubMed
    1. Schinstock CA, Stegall M, Cosio F. New insights regarding chronic antibody-mediated rejection and its progression to transplant glomerulopathy. Curr Opin Nephrol Hypertens. 2014;23(6):611–618. doi: 10.1097/MNH.0000000000000070. - DOI - PubMed

Publication types

Substances