Long-term progression pattern of chronic allograft dysfunction among kidney transplant recipients

There is little data about the pattern of disease
progression in kidney transplant recipients with chronic allograft
dysfunction (CAD). Extrapolating the current classification of chronic
kidney disease for CAD, we studied the pattern of progression of
CAD in 5 stages among our kidney transplant recipients.
Materials and Methods. We performed a retrospective cohort
study on 214 kidney transplant recipients with CAD. The selection
criteria were a functioning kidney allograft for at least 1 year after
transplantation and a progressive decline in allograft function. An
event history analysis in survival data was carried out based on
the stages of CAD at baseline and the end of the study.
Results. At the beginning of the study, 54.7% of the patients had
CAD stage 1; 37.9%, stage 2, and 7.5%, stage 3. At the end of
study, 10.3% were in stage 2; 39.7%, stage 3; 23.4%, stage 4; and
26.6%, stage 5. Patients with CAD stage 5 were 17.1% of those in
stage 1, 32.1% of those in stage 2, and 67.7% of those in stage 3
at baseline. There was a significant correlation between stage of
CAD at the beginning of the study and the stage of CAD at the
end (r = 0.465, P < .001).
Conclusions. Because the decline in kidney allograft function was
relatively faster in advanced stages of CAD, strategies to increase
allograft survival by improving the baseline level of allograft function
can be more effective than strategies to slow down progression of
advanced stages of CAD.