Choi Hoon Young, Huh Kyu Ha, Lee Jae Geun, Song Mi Kyung, Kim Myoung Soo, Kim Yu Seun, Kim Beom Seok
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
Department of Transplantation Surgery, Severance Hospital, Yonsei University Health System, Seoul, Korea.
PLoS One. 2016 Dec 14;11(12):e0168337. doi: 10.1371/journal.pone.0168337. eCollection 2016.
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.
肾移植（KT）后第一年的肾功能可预测肾移植的长期存活情况。本研究调查了KT后第一年估计肾小球滤过率（eGFR）的变异性是否是肾移植不良结局的危险因素。这项回顾性队列研究纳入了1979年至2012年间在Severance医院移植中心接受KT后1年重复eGFR测量的3077例患者。KT后第一年的eGFR变异性为预测指标。根据eGFR变异系数（eGFR-CV）将患者分为eGFR变异性的四个四分位数组。我们选择了一个eGFR-CV的临界值用于移植失败，并进行了敏感性分析。在所有患者中（Q4：HR 1.631，95%CI 1.278-2.081；p<0.0001）以及在无急性排斥反应（AR）的患者中（Q4：HR 1.425，95%CI 1.024-1.982；p=0.0358），在对KT后1年的eGFR和其他协变量进行调整后，eGFR变异性最高的四分位数组的移植结局比其他组更差。此外，在所有患者中，该最高四分位数组的全因死亡率高于其他组，但在无AR的患者中并非如此。在对所有协变量进行充分调整后，高于临界值的eGFR-CV与所有患者（HR 1.670，95%CI 1.395-2.000；p<0.0001）以及无AR的患者（HR 1.899，95%CI 1.457-2.477；p<0.0001）的移植失败高风险显著相关。对于全因死亡率，在调整协变量后，较高的eGFR-CV是所有患者中的独立危险因素，但在无AR的患者中并非如此。KT后第一年的eGFR变异性是肾移植不良结局的独立危险因素。
