Graft Function Variability and Slope and Kidney Transplantation Outcomes

Area of Science:

• Nephrology
• Transplantation Medicine
• Cardiovascular Research

Background:

• Identifying kidney transplant recipients (KTRs) at high risk for adverse outcomes is crucial for targeted monitoring and interventions.
• Graft function variability may be an important predictor of long-term outcomes in KTRs.

Purpose of the Study:

• To examine the association between graft function variability and long-term outcomes in KTRs.
• To determine if eGFR variability can improve risk prediction for adverse events in KTRs.

Main Methods:

• Observational study of 2919 KTRs with functioning allografts at 2 years posttransplantation.
• Calculated graft function slope and variability using linear regression of estimated glomerular filtration rate (eGFR) from outpatient measurements.
• Estimated associations of eGFR variability and slope with death, graft failure, cardiovascular events, and acute rejection.

Main Results:

• The highest quartile of eGFR variability was associated with a 1.85-fold increased risk of death, independent of eGFR and slope.
• eGFR variability was linked to higher risk of cardiovascular- and infection-related death and cardiovascular events.
• Variability of eGFR significantly improved prediction of mortality but not graft failure.

Conclusions:

• eGFR variability is independently associated with an increased risk of death, particularly cardiovascular disease-related death, in KTRs.
• eGFR variability is not associated with graft failure risk.
• eGFR variability may serve as a valuable tool to identify KTRs at higher risk for mortality and cardiovascular events.