Chronic allograft dysfunction in kidney transplant recipients: long-term single-center study

Area of Science:

• Nephrology
• Immunology
• Transplantation Science

Background:

• Chronic allograft dysfunction (CAD) is a significant long-term complication following kidney transplantation.
• Understanding the prevalence and risk factors for CAD is crucial for improving patient and graft outcomes.
• Previous studies have identified various factors, but a comprehensive analysis within a specific transplant center population is needed.

Purpose of the Study:

• To determine the prevalence of chronic allograft dysfunction (CAD) in kidney transplant recipients.
• To identify key immune and non-immune risk factors associated with the occurrence and progression of CAD.
• To analyze the impact of CAD on patient and graft survival rates.

Main Methods:

• Retrospective analysis of 637 kidney allograft recipients transplanted between 1990 and 2003.
• CAD diagnosis based on elevated creatinine (≥ 2 mg/dL), proteinuria, and worsening hypertension.
• Multivariate regression analysis to assess the influence of pre- and post-transplant factors on CAD progression.

Main Results:

• CAD developed in 43.1% of patients within 10 years post-transplantation, significantly impacting survival rates (80% patient survival, 42% graft survival).
• Major progression factors identified: proteinuria (OR: 11.3), elevated serum creatinine at 12 & 24 months (OR: 3.5 & 6.69), cytomegalovirus (CMV) infections (OR: 3.15), and male recipient gender (OR: 1.48).
• CAD patients exhibited higher rates of acute rejection, delayed graft function, UTIs, HCV infections, and had older donors and younger recipients with higher blood pressure and uric acid levels.

Conclusions:

• Chronic renal allograft dysfunction is a prevalent complication, affecting nearly half of patients within a decade.
• Proteinuria, persistent elevated creatinine levels, and CMV infections are critical predictors of CAD progression.
• CAD significantly diminishes both patient and allograft survival, highlighting the need for proactive management strategies.