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Parameters associated with chronic renal transplant failure
Summary
Chronic progressive renal transplant failure (CPTF) is linked to both immune and non-immune factors. Proteinuria, high blood pressure, and certain medication levels predict declining kidney function post-transplant.
Area of Science:
- Nephrology
- Transplantation Immunology
- Clinical Medicine
Background:
- Chronic progressive renal transplant failure (CPTF) is a major cause of end-stage renal disease.
- The exact pathogenesis of CPTF remains unclear, with potential roles for both immunological insults and metabolic mismatches.
- Similarities to chronic native kidney diseases suggest multifactorial causes for CPTF.
Purpose of the Study:
- To identify clinical parameters associated with CPTF.
- To define factors independently linked to the decline in kidney function after transplantation.
Main Methods:
- Retrospective analysis of 469 kidney transplant recipients.
- Creatinine clearance monitored for 2 years post-transplantation (mean follow-up 45 months).
- Univariate and multivariate regression analysis of immunological and non-immunological parameters.
Main Results:
- Proteinuria, systolic blood pressure, high Cyclosporin trough concentrations, and cumulative steroid dose were significantly associated with CPTF.
- Persistent proteinuria (> 2 g/d) predicted a > or = 25% decline in kidney function within 2 years with 83% positive predictive value.
- Both immune and non-immune factors independently correlated with CPTF.
Conclusions:
- Immunological and non-immunological factors are independently associated with declining excretory allograft function in the late post-operative period.
- Identifying these factors is crucial for managing and potentially preventing CPTF.