Pretransplant and early posttransplant predictors of chronic allograft nephropathy in cadaveric kidney allograft--a single-center analysis of 1112 cases.

This retrospective series reviews risk factors for chronic allograft nephropathy (CAN) based on the 10-year experience of a single institution. One thousand one hundred and twelve primary cadaveric renal transplant recipients whose graft survived for more than 6 months were followed for a mean of 4.6 years. The data were analyzed using the multivariate Cox proportional hazards model. CAN was defined as an irreversible rise of serum creatinine (SCr) by 30% in the absence of other causes and occurred in 42% of the patients. The risk of CAN was significantly increased in patients who experienced late rejections. Recipients of organs from donors that were older than 50 years and from such who died secondary to cerebrovascular accident were at increased risk of incurring CAN. Early markers of progression to CAN found at 6 months after transplantation included SCr levels of greater than 1.8 mg/ml, proteinuria, hypoalbuminemia, and hypertension. In conclusion, immune and non-immune factors affect progression to CAN in renal allograft recipients.