Estimated one-year glomerular filtration rate is the best predictor of long-term graft function following renal transplant.
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.
Salvadori
Maurizio
M
Renal Unit, Careggi University Hospital, Florence, Tuscany, Italy. salvadorim@ao-careggi.toscana.it
Rosati
Alberto
A
Bock
Andreas
A
Chapman
Jeremy
J
Dussol
Bertrand
B
Fritsche
Lutz
L
Kliem
Volker
V
Lebranchu
Yvon
Y
Oppenheimer
Federico
F
Pohanka
Erich
E
Tufveson
Gunnar
G
Bertoni
Elisabetta
E
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