title: Clinical Courses of Graft Failure Caused by Chronic Allograft Dysfunction in Kidney Transplantation.
abstract: BACKGROUND
  Chronic allograft dysfunction (CAD) is a main cause of graft failure in kidney transplantation.
  
  
  METHODS
  We retrospectively analyzed 279 kidney transplant recipients who survived with a functioning graft for at least 2 years. CAD was defined as chronic graft deterioration, excluding other specific causes. We defined the pattern of decline in estimated glomerular filtration rate (eGFR), as follows: (1) "plateau" was defined as decline in eGFR ≤2 mL/min/1.73 m2/year; "long plateaus" were those lasting more than 5 years; (2) "rapid decline" was a decrease in eGFR ≥20 mL/min/1.73 m2/year. Patients diagnosed with CAD were categorized according to the occurrence of rapid decline and/or long plateau as follows: group 1, neither rapid decline nor long plateau; group 2, rapid decline only; group 3, long plateau only; and group 4, both rapid decline and long plateau.
  
  
  RESULTS
  From a total of 81 graft losses, 51 (63%) failed because of CAD, with a median of 9.4 years. Sixteen patients belonged to group 1, 14 to group 2, 12 to group 3, and nine to group 4. Mean graft survival times in the four groups were 7.7 ± 1.1, 6.1 ± 3.1, 16.2 ± 2.5, and 10.8 ± 3.6 years, respectively (P < .001). There were significant differences among groups in donor age, year of transplantation, mean eGFR at baseline, and acute rejection rate after transplantation.
  
  
  CONCLUSIONS
  The results indicate that this cohort of kidney transplant recipients who had CAD comprised subgroups with different clinical courses.
authors.affiliation: Department of Surgery, National Hospital Organization, Okayama Medical Center, Okayama, Japan. Electronic address: takuzof@okayamamc.jp.
authors.forename: T
authors.initials: T
authors.lastname: Fujiwara
authors.affiliation: Department of Surgery, National Hospital Organization, Okayama Medical Center, Okayama, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Teruta
authors.affiliation: Department of Surgery, National Hospital Organization, Okayama Medical Center, Okayama, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Tsudaka
authors.affiliation: Department of Nephrology, National Hospital Organization, Okayama Medical Center, Okayama, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Ota
authors.affiliation: Department of Surgery, Saiwaicho Memorial Hospital, Okayama, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Matsuda
mesh_terms: D000328:Adult; D000367:Age Factors; D064591:Allografts / Q000503:physiopathology*; D005260:Female; D005919:Glomerular Filtration Rate; D006084:Graft Rejection / Q000209:etiology / Q000503:physiopathology*; D006085:Graft Survival; D006801:Humans; D007668:Kidney / Q000503:physiopathology; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000503:physiopathology*; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D055031:Primary Graft Dysfunction / Q000150:complications / Q000503:physiopathology*; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate