Late graft failure after kidney transplantation as the consequence of late versus early events

Robert S. Gaston, Ann Fieberg, Lawrence Hunsicker, Bertram L. Kasiske, Robert Leduc, Fernando G Cosio, Sita Gourishankar, Joseph Peter Grande, Roslyn B. Mannon, David Rush, J. Michael Cecka, John Connett, Arthur J. Matas

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Beyond the first posttransplant year, 3% of kidney transplants fail annually. In a prospective, multicenter cohort study, we tested the relative impact of early versus late events on risk of long-term death-censored graft failure (DCGF). In grafts surviving at least 90 days, early events (acute rejection [AR] and delayed graft function [DGF] before day 90) were recorded; serum creatinine (Cr) at day 90 was defined as baseline. Thereafter, a 25% rise in serum Cr or new-onset proteinuria triggered graft biopsy (index biopsy, IBx), allowing comparison of risk of DCGF associated with early events (AR, DGF, baseline serum Cr >2.0 mg/dL) to that associated with later events (IBx). Among 3678 patients followed for 4.7 ± 1.9 years, 753 (20%) had IBx at a median of 15.3 months posttransplant. Early AR (HR = 1.77, P < .001) and elevated Cr at Day 90 (HR = 2.56, P < .0001) were associated with increased risk of DCGF; however, later-onset dysfunction requiring IBx had far greater impact (HR = 13.8, P < .0001). At 90 days, neither clinical characteristics nor early events distinguished those who subsequently did or did not undergo IBx or suffer DCGF. To improve long-term kidney allograft survival, management paradigms should promote prompt diagnosis and treatment of both early and later events.

Original languageEnglish (US)
JournalAmerican Journal of Transplantation
DOIs
StateAccepted/In press - Jan 1 2017

Fingerprint

Kidney Transplantation
Transplants
Creatinine
Delayed Graft Function
Serum
Kidney
Biopsy
Proteinuria
Multicenter Studies
Allografts
Cohort Studies

Keywords

  • Chronic allograft nephropathy
  • Clinical research/practice
  • Delayed graft function (DGF)
  • Kidney (allograft) function/dysfunction
  • Kidney transplantation/nephrology
  • Rejection: acute

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)

Cite this

Gaston, R. S., Fieberg, A., Hunsicker, L., Kasiske, B. L., Leduc, R., Cosio, F. G., ... Matas, A. J. (Accepted/In press). Late graft failure after kidney transplantation as the consequence of late versus early events. American Journal of Transplantation. https://doi.org/10.1111/ajt.14590

Late graft failure after kidney transplantation as the consequence of late versus early events. / Gaston, Robert S.; Fieberg, Ann; Hunsicker, Lawrence; Kasiske, Bertram L.; Leduc, Robert; Cosio, Fernando G; Gourishankar, Sita; Grande, Joseph Peter; Mannon, Roslyn B.; Rush, David; Cecka, J. Michael; Connett, John; Matas, Arthur J.

In: American Journal of Transplantation, 01.01.2017.

Research output: Contribution to journalArticle

Gaston, RS, Fieberg, A, Hunsicker, L, Kasiske, BL, Leduc, R, Cosio, FG, Gourishankar, S, Grande, JP, Mannon, RB, Rush, D, Cecka, JM, Connett, J & Matas, AJ 2017, 'Late graft failure after kidney transplantation as the consequence of late versus early events', American Journal of Transplantation. https://doi.org/10.1111/ajt.14590
Gaston, Robert S. ; Fieberg, Ann ; Hunsicker, Lawrence ; Kasiske, Bertram L. ; Leduc, Robert ; Cosio, Fernando G ; Gourishankar, Sita ; Grande, Joseph Peter ; Mannon, Roslyn B. ; Rush, David ; Cecka, J. Michael ; Connett, John ; Matas, Arthur J. / Late graft failure after kidney transplantation as the consequence of late versus early events. In: American Journal of Transplantation. 2017.
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AU - Cosio, Fernando G

AU - Gourishankar, Sita

AU - Grande, Joseph Peter

AU - Mannon, Roslyn B.

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