Risk factors of long-term graft loss in renal transplant recipients with chronic allograft dysfunction

Graft loss owing to chronic allograft
dysfunction is a major concern in renal transplant
recipients. We assessed the affect of immune and
nonimmune risk factors on death-censored graft loss
in renal transplant recipients with chronic allograft
dysfunction.
Materials and Methods: We performed a
retrospective, single-center study on 214 renal
transplant recipients with chronic allograft
dysfunction among 1534 renal transplant recipients
at the Urmia University Hospital from 1997 to 2005.
Data registry includes details from all renal
transplants. The renal transplant recipient
information is regularly updated to determine current
graft function, graft loss, or renal transplant
recipient’s death. The selection criteria were a
functional renal allograft for at least 1 year and a
progressive decline in allograft function.
Results: Increasing donor age (RR=1.066; P < .001),
recipient age (RR=1.021, P = .0), recipient weight
(RR=1.024; P = .029), and waiting time on dialysis to
transplant. (RR=1.047; P = .006), pretransplant
hypertension (RR=3.126; P < .001), pretransplant
diabetes (RR=5.787; P < .001), delayed graft function
(RR=6.087; P < .001), proteinuria (RR=2.663; P = .001),
posttransplant diabetes (RR=2.285; P = .015),
posttransplant hypertension (RR=2.047; P = .017), and
AR (RR=3.125; P < .001). Patients in stage 2 at the
beginning of chronic allograft dysfunction relative to
stage 1 (RR=4.823; P < .001) and patients in stage 3 at
the beginning of chronic allograft dysfunction relative
to stage 1 (RR=123.06; P < .001) were significant risk
factors for death-censored graft loss. Using
mycophenolate mofetil versus azathioprine reduced
death-censored graft loss (RR=0.499; P ≤ .001).
Conclusion: We found that age of donor,
pretransplant hypertension, pretransplant diabetes,
type of immunosuppression (mycophenolate mofetil
vs azathioprine), delayed graft function, proteinuria,
and stage of allograft dysfunction at the start of
chronic allograft dysfunction are the major risk factors
for late renal allograft dysfunction.