Chronic kidney disease in kidney transplant recipients-is it different from chronic native kidney disease?

BACKGROUND: The rate of change in estimated glomerular filtration rate (ΔeGFR), factors influencing ΔeGFR, and its association with mortality has not been well studied in renal transplant recipients. METHODS.: Adult kidney-only recipients between January 2001 and December 2004, with surviving grafts 1 year after transplantation, from England and Wales were followed up till 31 December 2006, graft failure or death. The four variable modification of diet in renal disease equation was used to estimate GFR and ΔeGFR assessed using linear least square regression. ΔeGFR of -1 mL/min/1.73m per year and above was considered to be stable or improving function. Linear regression and Cox regression analyses were used to examine factors influencing ΔeGFR and its association with mortality, respectively. RESULTS: Of the 2, 927 patients included, ΔeGFR was -1.3±6.0 mL/min/1.73 m per year and eGFR remained stable or improved in the majority (54.8%). Baseline graft function at 1 year or live donor status did not influence ΔeGFR. Male donor to female recipient transplantation, younger recipients, diabetes, white race, and human leukocyte antigen mismatch were associated with faster decline in eGFR. ΔeGFR was not associated with mortality when censored for graft failure. CONCLUSIONS: Majority of renal transplant recipients experienced stable or improved graft function. Specific donor and recipient characteristics influenced the rate of decline in eGFR. The lack of association of ΔeGFR with mortality, the stability of eGFR in the majority, and influence of donor characteristics on ΔeGFR suggest caution when applying prognosis knowledge from the native kidney disease to the kidney transplant population.

Factors that influence access to the national renal transplant waiting list.

BACKGROUND: Registry data can be used to examine whether there are differences between individual renal units in the proportion of dialysis patients listed for renal transplantation, to investigate possible reasons for any differences observed, and to discover whether highlighting these anomalies can influence practice. METHODS: A cross-sectional study of 12, 401 prevalent adult dialysis patients from 41 renal units across England and Wales was performed. The proportion of patients registered on the deceased donor transplant waiting list was determined for each renal unit. Patient- and center-specific factors that influence the probability of being listed for transplantation were identified and used to adjust for differences observed between units. The annual change in the size of the transplant waiting list was examined before and after presentation of these data. RESULTS: A total of 23.3% of patients were active on the transplant waiting list. PATIENT: Specific variables significantly associated with listing were age, primary renal disease, graft number, social deprivation, and ethnicity but not gender. Centre-specific variables included size of renal unit, size of living donor program, and listing practice for living donor transplantation. Whether the renal unit was also a transplant unit was not significant. After adjusting for these variables, there remained unexplained variation between renal units in the proportion of dialysis patients on the waiting list. An increase in the number of patients listed for transplantation has been observed since presenting these data. CONCLUSIONS: Differences in listing practice exist between centers that cannot be explained by the patient case mix or center characteristics examined.

Renal after cardiothoracic transplant: the effect of repeat mismatches on outcome.

BACKGROUND: Histocompatibility matching is not considered important in nonrenal solid organ transplants (NRSOT). There is no evidence to base guidance on whether mismatched human leukocyte antigen (HLA) antigens should be avoided in subsequent renal transplantation. METHODS: This study examines the effect of repeat HLA mismatches on renal allograft survival and function in all renal after cardiothoracic transplants undertaken in the United Kingdom between 1997 and 2003 using the UK Transplant data. RESULTS: A repeat HLA-A, -B, or -DR mismatch occurred in 16 of 53 (30%) cases. Recipients without a repeat mismatch were more likely to be male, but recipient age, donor age, recipient-donor age difference, donor gender, donor type, or cold ischemia time were comparable. Immunosuppressive therapy was similar in both groups. No differences were observed in renal allograft function at 1 or 5 years between the repeat mismatch group (estimated glomerular filtration rate [mean+/-standard deviation] 41.6+/-16.6 and 37.5+/-12.8 mL/min/1.73 m2) and the no repeat mismatch group (47.2+/-15.7 and 48.0+/-15.9 mL/min/1.73 m2). Renal allograft survival was also similar in the two groups at 1 and 5 years. CONCLUSIONS: In this limited, heterogeneous, observational cohort of cardiothoracic transplant patients who went on to receive a sequential kidney transplant, a repeated HLA antigen mismatch was not associated with a detrimental effect on kidney transplant outcome.