title: An Improved Classification of Kidney Function Recovery Using Estimated Glomerular Filtration Rate Slope Post-transplantation.
abstract: BACKGROUND
  The impact of renal function recovery on graft survival was examined using estimated glomerular filtration rate (eGFR) slope after kidney transplantation (GAP classification); this was compared to the conventional classification of immediate graft function (IGF), slow graft function (SGF), and delayed graft function (DGF).
  
  
  METHODS
  Overall, 541 cases of cadaveric renal transplants were reviewed from a prospective transplant database. eGFR and its slope were measured using the harmonic mean over the first week post-transplantation. Next, 495 kidney transplant recipients from an independent institution were assessed to determine the prognostic value of graft function based on the eGFR slope.
  
  
  RESULTS
  The main discrimination of eGFR slopes occurred within the first 7 days. Three groups in the GAP classification (Good graft function, Average graft function, Poor graft function) were defined based on eGFR slope tertiles: good graft function (GGF), average graft function (AGF), and poor graft function (PGF) were defined based on the ΔCrCL per day over the first 7 days: <1 mL/min, 1-4 mL/min, and >4 mL/min, respectively. When applied to the validation cohort, the 5-year graft failure was 20% for the PGF group, 4% for the AGF group, and 3% for the GGF group. Multivariable Cox regression analysis demonstrated better prediction of long-term graft function with the new classification (C statistic 0.49 [old)] vs 0.61 [new]).
  
  
  CONCLUSIONS
  The new GAP criteria were better at predicting long-term graft survival and renal function compared to the conventional classification system, and deserve further consideration in future studies.
authors: Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia; Section of Hepatobiliary Surgery and Solid Organ Transplant, Department of Surgery, McGill University Health Center, Montréal, Québec, Canada.
authors: M
authors: M
authors: Hassanain
authors: Section of Hepatobiliary Surgery and Solid Organ Transplant, Department of Surgery, McGill University Health Center, Montréal, Québec, Canada.
authors: E
authors: E
authors: Simoneau
authors: Research School of Population Health, Australian National University, Canberra, Australia.
authors: S A
authors: SA
authors: Doi
authors: Département of Médicine, CHUM-Hôpital Notre-Dame, Médicine, Montréal, Québec, Canada.
authors: M-J
authors: MJ
authors: Hebert
authors: Section of Hepatobiliary Surgery and Solid Organ Transplant, Department of Surgery, McGill University Health Center, Montréal, Québec, Canada.
authors: P
authors: P
authors: Metrakos
authors: Section of Hepatobiliary Surgery and Solid Organ Transplant, Department of Surgery, McGill University Health Center, Montréal, Québec, Canada. Electronic address: jean.tchervenkov@muhc.mcgill.ca.
authors: J
authors: J
authors: Tchervenkov
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D051799:Delayed Graft Function / Q000145:classification* / Q000503:physiopathology; D005260:Female; D005919:Glomerular Filtration Rate; D006085:Graft Survival; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D020127:Recovery of Function; D012307:Risk Factors; D013997:Time Factors