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The variable nature of chronic declines in renal allograft function
B L Kasiske1, K L Heim-Duthoy, K L Tortorice
1Department of Medicine, Hennepin County Medical Center, Minneapolis, Minnesota 55415.
Transplantation
|February 1, 1991
Summary
Chronic declines in kidney transplant function have an unpredictable onset and variable course, impacting patient outcomes and dialysis return rates. Early post-transplant markers do not predict these declines, necessitating further research for better management strategies.
Area of Science:
- Nephrology
- Transplantation Immunology
- Clinical Trial Design
Background:
- Chronic declines in renal allograft function are poorly understood, affecting therapeutic trial design and clinical management.
- Characterizing the onset, progression, and clinical course of declining graft function is crucial for improving patient outcomes.
Purpose of the Study:
- To investigate the clinical setting, time of onset, and rate of progression for chronic declines in renal allograft function.
- To identify predictors of chronic allograft dysfunction and understand its impact on patient survival and return to dialysis.
Main Methods:
- Monthly estimates of glomerular filtration rate (E-GFR) were calculated using creatinine clearance and serum creatinine levels.
- A cohort of 200 kidney transplant recipients (pre-cyclosporine era) surviving at least 12 months post-transplant were analyzed.
- Chronic declines were modeled using regression analyses to determine onset and progression rates.
Main Results:
- 50 patients experienced gradual, chronic declines in E-GFR, with 56% returning to dialysis compared to 24% with acute declines and 2% with stable function.
- In 26% of cases, chronic declines began over 2 years post-transplant, and 40% showed spontaneous improvement in progression rate.
- Chronic declines were evident years before graft failure, but early clinical parameters failed to predict their development.
Conclusions:
- Chronic declines in renal allograft function exhibit unpredictable onset and variable clinical courses.
- Current early post-transplant monitoring parameters are insufficient for predicting the development of chronic allograft dysfunction.
- Further research is needed to develop predictive models and effective interventions for chronic allograft decline.