AUTHOR=Reimann Anna Vera , Nilsson Jakob , Wuethrich Rudolf P. , Mueller Thomas F. , Schachtner Thomas 

TITLE=Entering the Third Decade After Kidney Transplantation: Excellent Graft Function Refers to Superior Graft but Not Patient Survival

JOURNAL=Transplant International

VOLUME=Volume 35 - 2022

YEAR=2022

URL=https://www.frontierspartnerships.org/journals/transplant-international/articles/10.3389/ti.2022.10675

DOI=10.3389/ti.2022.10675

ISSN=1432-2277

ABSTRACT=Background
Kidney transplant recipients (KTRs) with ultralong-term survival represent a growing, yet insufficiently studied patient cohort.
Methods
In this single-center retrospective study, we analyzed 248 ultralong-term survivors (≥20 years). KTRs were classified into those with superior graft function (defined as eGFR ≥45mL/min + proteinuria ≤300mg/day + eGFR-slope ≤ 2mL/min/1.73m2/year) and inferior graft function regarding the risk of CKD progression. -
Results
20 years post-transplant, median eGFR was 54 mL/min (11-114), proteinuria 200 mg/24h (0-7620), eGFR decline  0.45 mL/min/1.73m2/year ( 11.7 6.5) and DSA had been detected in 19.7% of KTRs. We identified 96 KTRs (38.7%) with superior (group 1) and 152 KTRs (61.3%) with inferior graft function (group 2). Male sex (p=0.014), shorter time on dialysis (p=0.047), and lower donor age (p<0.001) were associated with superior graft function. Graft survival was significantly better in group 1 compared to group 2 (LogRank, p<0.001. Besides group affiliation (HR 20.515, p=0.003), multivariable analysis identified DSA development (HR 3.081, p=0.023) and donor age (HR 1.032, p=0.024) as independent factors. Interestingly, there was no significant difference in patient survival (LogRank, p=0.350).
Conclusions
In ultralong-term survivors, excellent graft function refers to superior graft survival but does not extend ultimate patient survival. DSA-formation should be taken seriously even in the ultralong-term.