Variables affecting estimated glomerular filtration rate after renal transplantation in children: a NAPRTCS data analysis.

Publication Type
Journal Article
Year of Publication
2010
Authors
Moudgil, A; Martz, K; Stablein, D M; Puliyanda, D P
Secondary
Pediatr Transplant
Volume
14
Pagination
288-94
Date Published
2010 Mar
Keywords
Adolescent; Child; Child, Preschool; Female; Glomerular filtration rate; Graft Survival; Humans; Infant; Kidney Diseases; kidney transplantation; Male; Registries
Abstract

Short-term graft survival has improved in renal transplants without significant effect on long-term graft survival. As GFR decline precedes graft loss, an understanding of variables affecting eGFR after TX may help improve graft survival. NAPRTCS data were analyzed to assess effects of donor, recipient, and other variables on Schwartz eGFR after transplantation. For 8438 children with a functioning graft at day 30, data were censored for children dying with a functioning graft, and those with <3 yr follow-up. Multivariate linear regression and repeated measures analyses identified factors related to eGFR at day 30 after TX and during follow-up. Young, female, non-black, children without ATN and acute rejection in the first 30 days, TX after 1995, those with better eGFR at day 30, and receiving tacrolimus had better long-term eGFR. Transplant from ideal (6-35 yr) donors had best short-term eGFR, young donors (<5 yr) had lower eGFR and poor graft survival. After one yr, eGFR improved in surviving grafts of young donors and matched ideal donors. Acute rejection, BP medications, and hospitalizations in prior six months had negative association with subsequent eGFR. Regardless of variables, eGFR deteriorated with time. Slope of eGFR decline has not changed in the recent era indicating the need for innovative therapies.