title: Understanding Trends in Kidney Function 1 Year after Kidney Transplant in the United States.
abstract: Lower eGFR 1 year after kidney transplant is associated with shorter allograft and patient survival. We examined how practice changes in the past decade correlated with time trends in average eGFR at 1 year after kidney transplant in the United States in a cohort of 189,944 patients who received a kidney transplant between 2001 and 2013. We calculated the average eGFR at 1 year after transplant for the recipient cohort of each year using the appropriate Modification of Diet in Renal Disease equation depending on the prevailing methodology of creatinine measurement, and used linear regression to model the effects of practice changes on the national post-transplant eGFR trend. Between the 2001-2005 period and the 2011-2013 period, average 1-year post-transplant eGFR remained essentially unchanged, with differences of 1.34 (95% confidence interval, 1.03 to 1.65) ml/min per 1.73 m2and 0.66 (95% confidence interval, 0.32 to 1.01) ml/min per 1.73 m2among deceased and living donor kidney transplant recipients, respectively. Over time, the mean age of recipients increased and more marginal organs were used; adjusting for these trends unmasked a larger temporal improvement in post-transplant eGFR. However, changes in immunosuppression practice had a positive effect on average post-transplant eGFR and balanced out the negative effect of recipient/donor characteristics. In conclusion, average 1-year post-transplant eGFR remained stable, despite increasingly unfavorable attributes in recipients and donors. With an aging ESRD population and continued organ shortage, preservation of average post-transplant eGFR will require sustained improvement in immunosuppression and other aspects of post-transplant care.
authors.affiliation: Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan.
authors.forename: Yihung
authors.initials: Y
authors.lastname: Huang
authors.affiliation: Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan.
authors.forename: Anca
authors.initials: A
authors.lastname: Tilea
authors.affiliation: Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan.
authors.forename: Brenda
authors.initials: B
authors.lastname: Gillespie
authors.affiliation: Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan.
authors.forename: Vahakn
authors.initials: V
authors.lastname: Shahinian
authors.affiliation: Division of Nephrology, Department of Medicine, University of California, San Francisco, California; and.
authors.forename: Tanushree
authors.initials: T
authors.lastname: Banerjee
authors.affiliation: Division of Nephrology, Department of Medicine, University of California, San Francisco, California; and.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Grubbs
authors.affiliation: Division of Nephrology, Department of Medicine, University of California, San Francisco, California; and.
authors.forename: Neil
authors.initials: N
authors.lastname: Powe
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Nilka
authors.initials: N
authors.lastname: Rios-Burrows
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Meda
authors.initials: M
authors.lastname: Pavkov
authors.affiliation: Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan; rsaran@med.umich.edu.
authors.forename: Rajiv
authors.initials: R
authors.lastname: Saran
mesh_terms: D000368:Aged; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007668:Kidney / Q000502:physiology*; D007677:Kidney Function Tests; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D014481:United States
keywords: chronic kidney disease; glomerular filtration rate; transplantation