Kidney allograft function and histology in recipients dying with a functioning graft

E. C. Lorenz, Z. M. El-Zoghby, H. Amer, P. G. Dean, M. A. Hathcock, W. K. Kremers, M. D. Stegall, F. G. Cosio

Research output: Contribution to journalArticle

5 Scopus citations

Abstract

Death with function (DWF) is a major cause of kidney allograft failure. Allograft dysfunction may contribute to DWF. The aim of this study was to examine the relationship between DWF and allograft function using estimated GFR (eGFR) and histology. We retrospectively analyzed 1842 kidney allografts transplanted at our center from 1996 to 2010. eGFR was estimated using the MDRD equation. Biopsies obtained 12 months posttransplant and within 1 year of DWF were analyzed. Proportional hazards models were used to examine the relationship between eGFR and DWF. During 68-±-43 months of follow-up, 14% (n-=-256) of recipients experienced DWF. Risk factors of DWF included increasing recipient age (hazard ratio [HR]-=-2.07, confidence interval [CI] 1.77-2.43, p-<-0.0001), diabetes (HR-=-2.58, CI 1.81-3.69, p-<-0.0001), prior dialysis (HR-=-1.47, CI 1.05-2.06, p-=-0.03) and eGFR <40-mL/min/1.73-m 2 (HR 2.26 per 10-mL/min/1.73-m2 decrease in eGFR, CI 1.82-2.81, p-<-0.0001). Prior to death, only 15.9% (n-=-39) of DWF recipients had stage 4 chronic kidney disease (CKD) and only 4.9% (n-=-12) had stage 5 CKD. Most biopsies performed within 1 year of DWF (68%) demonstrated benign histology and were comparable to biopsies from matched controls. In conclusion, allograft dysfunction is independently associated with DWF. However, the majority of DWF recipients have well-preserved allograft function and histology prior to death. This retrospective study examining death with function in kidney transplant recipients finds that the majority of death with function recipients have well-preserved allograft function and histology prior to death.

Original languageEnglish (US)
Pages (from-to)1612-1618
Number of pages7
JournalAmerican Journal of Transplantation
Volume14
Issue number7
DOIs
StatePublished - Jul 2014

Keywords

  • Clinical research/practice
  • glomerular filtration rate (GFR)
  • kidney (allograft) function/dysfunction
  • kidney transplantation/nephrology

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)

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