Association Between a Change in Donor Kidney Function and Long-Term Allograft Outcomes in Kidney Transplant Recipients

Abstract

Reserve capacity of donated kidney may be an important determinant of allograft survival in kidney transplantation (KT). Here, we investigate change in estimated glomerular filtration rate of donor kidney (Delta eGFR(Donor)) over 30 days after KT as a predictor of the allograft function. A total of 222 recipients were divided into two groups according to Delta eGFR(Donor) as follows: Group I (n = 110), Delta eGFR(Donor) >= -25%; Group II (n = 112), Delta eGFR(Donor) < -25%. Three years after KT, Group I had a higher eGFR(Recipient) than Group II (55 +/- 21 vs. 47 +/- 22 mL/min/1.73 m(2), P < 0.05). However, no differences in eGFR(Recipient) were detected between the two groups after 10 years. Linear regression analysis showed that Delta eGFR(Donor) was significantly associated with the eGFR(Recipient) at 3 years post-transplantation, but not at 10 years post-transplantation. In Kaplan-Meier analysis, Group I had a greater dialysis-free survival rate than Group II at the 10-year follow-up (84% vs. 76%, P < 0.05). However, no difference in overall survival rate between groups was detected. In the multivariate-adjusted Cox proportional-hazard model, Delta eGFR(Donor) was independently associated with future allograft loss (hazard ratio 0.973; 95% confidence interval 0.949-0.999). These results suggest that larger recovery of donor kidney function after KT donation is associated with better short/intermediate-term allograft outcomes. Follow-up assessment of donor kidney function may be useful to monitor KT recipients at risk for allograft loss.