title: Long-term progression pattern of chronic allograft dysfunction among kidney transplant recipients.
abstract: BACKGROUND
  There is little data about the pattern of disease progression in kidney transplant recipients with chronic allograft dysfunction (CAD). Extrapolating the current classification of chronic kidney disease for CAD, we studied the pattern of progression of CAD in 5 stages among our kidney transplant recipients.
  
  
  METHODS
  We performed a retrospective cohort study on 214 kidney transplant recipients with CAD. The selection criteria were a functioning kidney allograft for at least 1 year after transplantation and a progressive decline in allograft function. An event history analysis in survival data was carried out based on the stages of CAD at baseline and the end of the study.
  
  
  RESULTS
  At the beginning of the study, 54.7% of the patients had CAD stage 1; 37.9%, stage 2, and 7.5%, stage 3. At the end of study, 10.3% were in stage 2; 39.7%, stage 3; 23.4%, stage 4; and 26.6%, stage 5. Patients with CAD stage 5 were 17.1% of those in stage 1, 32.1% of those in stage 2, and 67.7% of those in stage 3 at baseline. There was a significant correlation between stage of CAD at the beginning of the study and the stage of CAD at the end (r = 0.465, P < .001).
  
  
  CONCLUSIONS
  Because the decline in kidney allograft function was relatively faster in advanced stages of CAD, strategies to increase allograft survival by improving the baseline level of allograft function can be more effective than strategies to slow down progression of advanced stages of CAD.
authors.affiliation: Department of Biostatistics, Tarbiat Modares University, Tehran, Iran.
authors.forename: Hamid Reza
authors.initials: HR
authors.lastname: Khalkhali
authors.forename: Ebrahim
authors.initials: E
authors.lastname: Hajizadeh
authors.forename: Anoushirvan
authors.initials: A
authors.lastname: Kazemnejad
authors.forename: Ali
authors.initials: A
authors.lastname: Ghafari
mesh_terms: D018450:Disease Progression; D005260:Female; D005919:Glomerular Filtration Rate; D006084:Graft Rejection / Q000503:physiopathology*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000503:physiopathology*; D016030:Kidney Transplantation; D008297:Male; D012189:Retrospective Studies; D015996:Survival Rate; D014184:Transplantation, Homologous