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Variability of the Estimated Glomerular Filtration Rate in the First Year after Kidney Transplantation Is an Independent Risk Factor for Poor Renal Allograft Outcomes: A Retrospective Cohort Study

Authors
 Hoon Young Choi  ;  Kyu Ha Huh  ;  Jae Geun Lee  ;  Mi Kyung Song  ;  Myoung Soo Kim  ;  Yu Seun Kim  ;  Beom Seok Kim 
Citation
 PLoS One, Vol.11(12) : e0168337, 2016 
Journal Title
 PLoS One 
Issue Date
2016
Abstract
Renal function in the first year after kidney transplantation (KT) can predict long-term renal graft survival. This study investigated whether estimated glomerular filtration rate (eGFR) variability during the first year after KT is a risk factor for poor renal allograft outcomes. This retrospective cohort study included 3077 patients who underwent repeated eGFR measurements for 1 year after KT at Severance Hospital Transplantation Center between 1979 and 2012. The eGFR variability during the first year after KT was the predictor. The patients were divided into four quartile groups of eGFR variability according to the coefficient of variation for eGFR (eGFR-CV). We selected a cutoff of eGFR-CV for graft failure and performed the sensitivity analyses. The graft outcome was worse in the highest quartile group of eGFR variability than in the other groups among all patients (Q4: HR 1.631, 95% CI 1.278-2.081; p < 0.0001) and among patients without AR (Q4: HR 1.425, 95% CI 1.024-1.982; p = 0.0358) after adjusting for eGFR at 1 year after KT and other covariates. Additionally, all-cause mortality was higher in this highest quartile group than in the other groups among all patients but not among patients without AR. Higher eGFR-CVs than the cutoff were significantly associated with a high risk of graft failure among all patients (HR 1.670, 95% CI 1.395-2.000; p < 0.0001) and among patients without AR (HR 1.899, 95% CI 1.457-2.477; p < 0.0001) after fully adjusting for covariates. For all-cause mortality, a higher eGFR-CV was an independent risk factor among all patients but not among patients without AR after adjusting for covariates. eGFR variability in the first year after KT is an independent risk factor for poor renal allograft outcomes.
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DOI
10.1371/journal.pone.0168337
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
김명수(Kim, Myoung Soo) ORCID logo https://orcid.org/0000-0002-8975-8381
김범석(Kim, Beom Seok) ORCID logo https://orcid.org/0000-0002-5732-2583
김유선(Kim, Yu Seun) ORCID logo https://orcid.org/0000-0002-5105-1567
이재근(Lee, Jae Geun) ORCID logo https://orcid.org/0000-0002-6722-0257
최훈영(Choi, Hoon Young) ORCID logo https://orcid.org/0000-0002-4245-0339
허규하(Huh, Kyu Ha) ORCID logo https://orcid.org/0000-0003-1364-6989
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URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/152720
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