Association Between Time Spent With Low Posttransplant Glomerular Filtration Rate and Access to Relisting and Retransplantation.

RATIONALE &

OBJECTIVE

For transplant recipients with low estimated glomerular filtration rate (eGFR), early preparation is needed to optimize the transition back to dialysis or retransplantation. Our objective was to determine if the amount of time spent with low eGFR was associated with a higher likelihood of relisting or retransplantation within 1 year of graft failure.

STUDY

DESIGN

Retrospective cohort study.

SETTING &

PARTICIPANTS

We included adults who developed graft failure between 2010 and 2021 according to the US Renal Data System.

EXPOSURE: We modeled the time spent with eGFR between 20 and 5 mL/min/1.73 m2 using available serum creatinine values reported annually (henceforth referred to as time with low eGFR).

OUTCOME: Relisting or retransplantation within 1 year of graft failure.

ANALYTICAL APPROACH: We used Fine-Gray models accounting for the competing risk of death to determine the association between time spent with low eGFR (as a categorical variable) and outcomes of interest.

RESULTS

We included 14,680 patients; median age at graft failure was 53 years (IQR, 42-61). Within 1 year of graft failure, ∼18% (n = 2,690) of patients were relisted and 13% (n = 1,854) were retransplanted. In adjusted models, spending 2-4 years (SHR, 1.43; 95% confidence interval [CI], 1.16-1.75) or >4 years (SHR, 1.28; 95% CI, 1.04-1.57) with low eGFR was associated with a higher likelihood of relisting (vs spending <2 years with low eGFR). Similarly, spending 2-4 years (SHR, 1.37; 95% CI, 1.09-1.72) or >4 years (SHR, 1.73; 95% CI, 1.37-2.19) with low eGFR was also associated with a higher likelihood of retransplantation within 1 year of graft failure.

LIMITATIONS: Residual confounding; observational nature of study.

CONCLUSIONS

Timely preparation of patients with low eGFR for retransplantation could increase patients' likelihood of early relisting and retransplantation.