Associations of renal function at 1-year after kidney transplantation with subsequent return to dialysis, mortality, and healthcare costs

Transplantation. 2011 Jun 27;91(12):1347-56. doi: 10.1097/TP.0b013e31821ab993.


Background: Improved early kidney transplant outcomes limit the contemporary utility of standard clinical endpoints. Quantifying the relationship of renal function at 1 year after transplant with subsequent clinical outcomes and healthcare costs may facilitate cost-benefit evaluations among transplant recipients.

Methods: Data for Medicare-insured kidney-only transplant recipients (1995-2003) were drawn from the United States Renal Data System. Associations of estimated glomerular filtration rate (eGFR) level at the first transplant anniversary with subsequent death-censored graft failure and patient death in posttransplant years 1 to 3 and 4 to 7 were examined by parametric survival analysis. Associations of eGFR with total health care costs defined by Medicare payments were assessed with multivariate linear regression.

Results: Among 38,015 participants, first anniversary eGFR level demonstrated graded associations with subsequent outcomes. Compared with patients with 12-month eGFR more than or equal to 60 mL/min/1.73 m, the adjusted relative risk of death-censored graft failure in years 1 to 3 was 31% greater for eGFR 45 to 59 mL/min/1.73 m (P<0.0001) and 622% greater for eGFR 15 to 30 mL/min/1.73 m (P<0.0001). Associations of first anniversary eGFR level with graft failure and mortality remained significant in years 4 to 7. The proportions of recipients expected to return to dialysis or die attributable to eGFR less than 60 mL/min/1.73 m over 10 years were 23.1% and 9.4%, respectively, and were significantly higher than proportions attributable to delayed graft function or acute rejection. Reduced eGFR was associated with graded and significant increases in health care spending during years 2 and 3 after transplant (P<0.0001).

Conclusion: eGFR is strongly associated with clinical and economic outcomes after kidney transplantation.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Female
  • Glomerular Filtration Rate
  • Graft Rejection
  • Graft Survival
  • Health Care Costs
  • Humans
  • Kidney / physiology
  • Kidney Transplantation / economics*
  • Kidney Transplantation / methods*
  • Male
  • Medicare
  • Middle Aged
  • Regression Analysis
  • Renal Dialysis / economics
  • Renal Dialysis / methods
  • Treatment Outcome
  • United States