Trajectories of glomerular filtration rate and progression to end stage kidney disease after kidney transplantation

Although the gold standard of monitoring kidney transplant function relies on glomerular filtration rate (GFR), little is known about GFR trajectories after transplantation, their determinants, and association with outcomes. To evaluate these parameters we examined recipients receiving care at 15 academic centers. Patients underwent prospective estimated (eGFR) measurements, assessment clinical, functional, histological immunological parameters. Additional validation took place in seven randomized controlled trials that included a total 14,132 patients 403,497 eGFR measurements. After median follow-up 6.5 years, 1,688 developed end-stage disease. Using unsupervised latent class mixed models, identified eight distinct trajectories. Multinomial regression models significant determinants including donor age, eGFR, proteinuria, several features: graft scarring, interstitial inflammation tubulitis, microcirculation inflammation, circulating anti-HLA specific antibodies. The were associated progression to end stage These trajectories, respective associations disease similar across cohorts, as well diverse clinical scenarios, therapeutic eras control trials. Thus, our results provide basis for trajectory-based risk stratification monitoring. Predicting long-term allograft outcomes: pitfalls progressKidney InternationalVol. 99Issue 1PreviewEarly identification progressive dysfunction may allow clinicians closer more aggressive factor modification. In this issue, Raynaud et al. presented model clustered into 8 categories post-transplant loss. This commentary discusses some advantages, but also challenges, use analyses, applicability are often derived from such approaches. Full-Text PDF