Prognostic value for long-term graft survival of estimated glomerular filtration rate and proteinuria quantified at 3 months after kidney transplantation
Authors: Mottola Clément , Girerd Nicolas , Duarte Kevin , Aarnink Alice , Giral Magali , Dantal Jacques , Garrigue Valérie , Mourad Georges , Buron Fanny , Morelon Emmanuel , Ladrière Marc , Kessler Michèle , Frimat Luc , Girerd Sophie ,   for the DIVAT Consortium, Blancho Gilles , Branchereau Julien , Cantarovich Diego , Chapelet Agnès , Dantal Jacques , Deltombe Clément , Figueres Lucile , Garandeau Claire , Gourraud-Vercel Caroline , Hourmant Maryvonne , Karam Georges , Kerleau Clarisse , Meurette Aurélie , Ville Simon , Kandell Christine , Moreau Anne , Renaudin Karine , Cesbron Anne , Delbos Florent , Walencik Alexandre , Devis Anne , Eschbach Valérie , Eschwege Pascal , Hubert Jacques , Laurain Emmanuelle , Leblanc Louis , Lecoanet Pierre , Lemelle Jean-Louis , Badet Lionel , Brunet Maria , Cahen Rémi , Daoud Sameh , Fournie Coralie , Grégoire Arnaud , Koenig Alice , Lévi Charlène , Pouteil-Noble Claire , Rimmelé Thomas , Thaunat Olivier , Delmas Sylvie , Garrigue Valérie , Le Quintrec Moglie , Pernin Vincent , Serre Jean-Emmanuel , Le Floch S , Scellier C , Eschbach V , Zurbonsen K , Dagot C , M’Raiagh F , Godel V , Blancho Gilles , Branchereau Julien , Cantarovich Diego , Chapelet Agnès , Dantal Jacques , Deltombe Clément , Figueres Lucile , Garandeau Claire , Gourraud-Vercel Caroline , Hourmant Maryvonne , Karam Georges , Kerleau Clarisse , Meurette Aurélie , Ville Simon , Kandell Christine , Moreau Anne , Renaudin Karine , Cesbron Anne , Delbos Florent , Walencik Alexandre , Devis Anne , Eschbach Valérie , Eschwege Pascal , Hubert Jacques , Laurain Emmanuelle , Leblanc Louis , Lecoanet Pierre , Lemelle Jean-Louis , Badet Lionel , Brunet Maria , Cahen Rémi , Daoud Sameh , Fournie Coralie , Grégoire Arnaud , Koenig Alice , Lévi Charlène , Pouteil-Noble Claire , Rimmelé Thomas , Thaunat Olivier , Delmas Sylvie , Garrigue Valérie , Le Quintrec Moglie , Pernin Vincent , Serre Jean-Emmanuel , Le Floch S , Scellier C , Eschbach V , Zurbonsen K , Dagot C , M’Raiagh F , Godel V 
Published: March 2020

Abstract

Background
The estimated glomerular filtration rate (eGFR) measured at 1 year is the usual benchmark applied in kidney transplantation (KT). However, acting on earlier eGFR values could help in managing KT during the first post-operative year. We aimed to assess the prognostic value for long-term graft survival of the early (3 months) quantification of eGFR and proteinuria following KT.

Methods
The 3-, 6- and 12-month eGFR using the Modified Diet in Renal Disease equation (eGFRMDRD) was determined and proteinuria was measured in 754 patients who underwent their first KT between 2000 and 2010 (with a mean follow-up of 8.3 years) in our centre. Adjusted associations with graft survival were estimated using a multivariable Cox model. The predictive accuracy was estimated using the C-index and net reclassification index. These same analyses were measured in a multicentre validation cohort of 1936 patients.

Results
Both 3-month eGFRMDRD and proteinuria were independent predictors of return to dialysis (all P &lt; 0.05) and there was a strong correlation between eGFR at 3 and 12 months (Spearman’s ρ = 0.76). The predictive accuracy of the 3-month eGFR was within a similar range and did not differ significantly from the 12-month eGFR in either the derivation cohort [C-index 62.6 (range 57.2–68.1) versus 66.0 (range 60.1–71.9), P = 0.41] or the validation cohort [C-index 69.3 (range 66.4–72.1) versus 71.7 (range 68.7–74.6), P = 0.25].

Conclusion
The 3-month eGFR was a valuable predictor of the long-term return to dialysis whose predictive accuracy was not significantly less than that of the 12-month eGFR in multicentre cohorts totalling &gt;2500 patients. Three-month outcomes may be useful in randomized controlled trials targeting early therapeutic interventions.