title: Identification and characterization of kidney transplants with good glomerular filtration rate at 1 year but subsequent progressive loss of renal function.
abstract: BACKGROUND
  After the first year after kidney transplantation, 3% to 5% of grafts fail each year but detailed studies of how grafts progress to failure are lacking. This study aimed to analyze the functional stability of kidney transplants between 1 and 5 years after transplantation and to identify initially well-functioning grafts with progressive decline in allograft function.
  
  
  METHODS
  The study included 788 adult conventional kidney transplants performed at the Mayo Clinic Rochester between January 2000 and December 2005 with a minimum graft survival and follow-up of 2.6 years. The modification of diet in renal disease equation for estimating glomerular filtration rate (eGFR(MDRD)) was used to calculate the slope of renal function over time using all available serum creatinine values between 1 and 5 years after transplantation.
  
  
  RESULTS
  Most transplants demonstrated good function (eGFR(MDRD) ≥40 mL/min) at 1 year with positive eGFR(MDRD) slope between 1 and 5 years after transplantation. However, a subset of grafts with 1-year eGFR(MDRD) ≥40 mL/min exhibited strongly negative eGFR(MDRD) slope between 1 and 5 years suggestive of progressive loss of graft function. Forty-one percent of this subset reached graft failure during follow-up, accounting for 69% of allograft failures occurring after 2.5 years after transplantation. This pattern of progressive decline in estimated glomerular filtration rate despite good early function was associated with but not fully attributable to factors suggestive of enhanced antidonor immunity.
  
  
  CONCLUSIONS
  Longitudinal analysis of serial estimated glomerular filtration ratemeasurements identifies initially well-functioning kidney transplants at high risk for subsequent graft loss. For this subset, further studies are needed to identify modifiable causes of functional decline.
authors.affiliation: William J von Liebig Transplant Center, Mayo Clinic, Rochester, MN 55905, USA.
authors.forename: Walter D
authors.initials: WD
authors.lastname: Park
authors.forename: Timothy S
authors.initials: TS
authors.lastname: Larson
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Griffin
authors.forename: Mark D
authors.initials: MD
authors.lastname: Stegall
mesh_terms: D000328:Adult; D003404:Creatinine / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate / Q000276:immunology / Q000502:physiology*; D006084:Graft Rejection / Q000453:epidemiology / Q000276:immunology; D006085:Graft Survival / Q000276:immunology / Q000502:physiology*; D006801:Humans; D015994:Incidence; D007668:Kidney / Q000276:immunology / Q000502:physiology*; D016030:Kidney Transplantation / Q000276:immunology / Q000502:physiology*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors
chemical_list: D003404:Creatinine