title: Estimated one-year glomerular filtration rate is the best predictor of long-term graft function following renal transplant.
abstract: BACKGROUND
  Long-term success of renal transplantation depends upon the quality of the donor organ, avoidance of peritransplant and early posttransplant damage (rejection), and optimal maintenance of graft function after the first 6-12 months. Glomerular filtration rate (GFR) at 1 year is a standard way to evaluate short-term success, whereas calculated GFR at 5 years gives a better appreciation of long-term outcomes. The objective of this study was to assess the effect of various demographic and transplant-related parameters on renal function via GFR at 1 year and 5 years post transplantation, using univariate and multivariate data analysis.
  
  
  METHODS
  Data on 1-year GFR were available from 10,397 patients, whereas 2,889 patients provided data on both 1-year and 5-year GFR. All patients were enrolled in the Neoral Multinational Observational Study in Transplantation (Neoral-MOST), an ongoing, prospective, observational study of adult renal transplant recipients.
  
  
  RESULTS
  One-year GFR was the most relevant predictor for 5-year GFR. In a multifactorial analysis (ANCOVA) using 1-year GFR as a continuous variable, the effects of several highly relevant parameters from univariate analysis (such as acute rejection and delayed graft function) on 5-year GFR appeared to be fully mediated by their influence on 1-year GFR, whereas immunological risk factors like HLA match or previous transplantation had an ongoing effect on graft function beyond year 1.
  
  
  CONCLUSIONS
  The findings of this study corroborate and augment data from previous registry surveys, and confirm the importance of observational studies in investigating the role of peritransplant parameters on long-term graft outcome.
authors.affiliation: Renal Unit, Careggi University Hospital, Florence, Tuscany, Italy. salvadorim@ao-careggi.toscana.it
authors.forename: Maurizio
authors.initials: M
authors.lastname: Salvadori
authors.forename: Alberto
authors.initials: A
authors.lastname: Rosati
authors.forename: Andreas
authors.initials: A
authors.lastname: Bock
authors.forename: Jeremy
authors.initials: J
authors.lastname: Chapman
authors.forename: Bertrand
authors.initials: B
authors.lastname: Dussol
authors.forename: Lutz
authors.initials: L
authors.lastname: Fritsche
authors.forename: Volker
authors.initials: V
authors.lastname: Kliem
authors.forename: Yvon
authors.initials: Y
authors.lastname: Lebranchu
authors.forename: Federico
authors.initials: F
authors.lastname: Oppenheimer
authors.forename: Erich
authors.initials: E
authors.lastname: Pohanka
authors.forename: Gunnar
authors.initials: G
authors.lastname: Tufveson
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Bertoni
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D005260:Female; D005919:Glomerular Filtration Rate; D006085:Graft Survival / Q000502:physiology*; D006801:Humans; D016030:Kidney Transplantation / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome