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Serial estimation of glomerular filtration rate in children after renal transplant
J M Sorof1, S L Goldstein, E D Brewer
1Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA. jsorof@texaschildrenshospital.org
Insights
Serial monthly estimated glomerular filtration rate (eGFR) effectively tracks pediatric renal allograft outcomes. This method identifies risk factors like acute rejection and donor type impacting graft function over time.
Area of Science:
- Pediatric Nephrology
- Transplantation Immunology
- Renal Physiology
Background:
- Assessing pediatric renal allograft outcomes is crucial for long-term patient health.
- Serial monitoring of estimated glomerular filtration rate (eGFR) is a potential tool for evaluating graft function.
Purpose of the Study:
- To determine the validity of serial monthly eGFR measurements in pediatric renal transplant recipients.
- To investigate the impact of risk factors for renal allograft failure on eGFR trends.
Main Methods:
- Retrospective analysis of a single-center cohort of pediatric renal transplant recipients.
- Monthly collection of clinical data including height, weight, serum creatinine, rejection episodes, and cyclosporine levels.
- Calculation of eGFR using the Schwartz formula, with data analyzed across 6-month intervals up to 5 years post-transplant.
Main Results:
- Overall mean eGFR declined from 75 ml/min/1.73 m² at 6 months-1 year to 46 ml/min/1.73 m² at 4.5-5 years.
- Lower eGFR was observed in recipients of cadaveric versus living-related donor grafts and in those with acute rejection episodes (P<0.01).
- Post-transplant, Black recipients showed lower eGFR than White or Hispanic recipients (P<0.01); higher cyclosporine doses impacted early and late graft function differently.
Conclusions:
- Serial monthly eGFR assessment is a valid outcome variable for studying chronic renal allograft dysfunction in children.
- Identified risk factors (donor type, acute rejection, race) significantly influence eGFR trajectories.
- Findings align with multi-center studies using graft failure as the primary outcome.
Abstract:
Evaluation of serial monthly estimated glomerular filtration rate (eGFR) may be useful for studying pediatric renal allograft outcome. To determine the validity of this approach, we reviewed our single-center experience in pediatric renal transplant recipients to determine the effect of risk factors for renal allograft failure on eGFR. Clinical parameters recorded monthly through 5 years post transplant allowed serial assessment of eGFR. Monthly clinical data included height, weight, serum creatinine, cumulative number of acute rejection episodes, cyclosporine dose, and cyclosporine trough levels. From these data, eGFR was calculated monthly for each patient using the Schwartz formula. Time post transplant was grouped in 6-month intervals and plotted against mean eGFR to compare eGFR in patients grouped by demographic and clinical factors; 1,786 monthly data sets from 6 months post transplant (n=76 patients) to 5 years post transplant (n=25 patients) were analyzed. Overall mean eGFR from 6 months to 1 year was 75 ml/min per 1.73 m(2) and from 4. 5 to 5 years 46 ml/min per 1.73 m(2). eGFR was lower at all time intervals for recipients of cadaver versus living-related donor grafts, and patients with >/=1 versus 0 acute rejections (P<0.01). After 1 year, eGFR was lower in black patients compared with white or Hispanic patients (P<0.01). Cyclosporine dose greater than 5 mg/kg per day was associated with better early and worse late graft function. These results are similar to those reported in multi-center studies using the outcome variable of graft failure and suggest that serial eGFR may be valid as an outcome variable to study chronic renal allograft dysfunction in children.