title: Risk factors of long-term graft loss in renal transplant recipients with chronic allograft dysfunction.
abstract: OBJECTIVE
  Graft loss owing to chronic allograft dysfunction is a major concern in renal transplant recipients. We assessed the affect of immune and nonimmune risk factors on death-censored graft loss in renal transplant recipients with chronic allograft dysfunction.
  
  
  METHODS
  We performed a retrospective, single-center study on 214 renal transplant recipients with chronic allograft dysfunction among 1534 renal transplant recipients at the Urmia University Hospital from 1997 to 2005. Data registry includes details from all renal transplants. The renal transplant recipient information is regularly updated to determine current graft function, graft loss, or renal transplant recipient's death. The selection criteria were a functional renal allograft for at least 1 year and a progressive decline in allograft function.
  
  
  RESULTS
  Increasing donor age (RR=1.066; P < .001), recipient age (RR=1.021, P = .00), recipient weight (RR=1.024; P = .029), and waiting time on dialysis to transplant (RR=1.047; P = .006), pretransplant hypertension (RR=3.126; P < .001), pretransplant diabetes (RR=5.787; P < .001), delayed graft function (RR=6.087; P < .001), proteinuria (RR=2.663; P = .001), posttransplant diabetes (RR=2.285; P = .015), posttransplant hypertension (RR=2.047; P = .017), and AR (RR=3.125; P < .001). Patients in stage 2 at the beginning of chronic allograft dysfunction relative to stage 1 (RR=4.823; P < .001) and patients in stage 3 at the beginning of chronic allograft dysfunction relative to stage 1 (RR=123.06; P < .001) were significant risk factors for death-censored graft loss. Using mycophenolate mofetil versus azathioprine reduced death-censored graft loss (RR=0.499; P = .001).
  
  
  CONCLUSIONS
  We found that age of donor, pretransplant hypertension, pretransplant diabetes, type of immunosuppression (mycophenolate mofetil vs azathioprine), delayed graft function, proteinuria, and stage of allograft dysfunction at the start of chronic allograft dysfunction are the major risk factors for late renal allograft dysfunction.
authors.affiliation: University Department of Biostatistics, Department of Internal Medicine. ghaf_ali@yahoo.com
authors.forename: Hamid Reza
authors.initials: HR
authors.lastname: Khalkhali
authors.forename: Ali
authors.initials: A
authors.lastname: Ghafari
authors.forename: Ebrahim
authors.initials: E
authors.lastname: Hajizadeh
authors.forename: Anoushirvan
authors.initials: A
authors.lastname: Kazemnejad
mesh_terms: D000328:Adult; D000367:Age Factors; D002908:Chronic Disease; D051799:Delayed Graft Function / Q000209:etiology / Q000503:physiopathology; D048909:Diabetes Complications / Q000209:etiology; D005260:Female; D006084:Graft Rejection / Q000209:etiology*; D006085:Graft Survival; D006801:Humans; D006973:Hypertension / Q000150:complications; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007492:Iran; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000503:physiopathology*; D007674:Kidney Diseases / Q000209:etiology* / Q000503:physiopathology; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D016016:Proportional Hazards Models; D011507:Proteinuria / Q000209:etiology / Q000503:physiopathology; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014184:Transplantation, Homologous; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents