Association Between Time Spent With Low Post-transplant Glomerular Filtration Rate and Access to Relisting and Retransplantation

Rationale & Objective: For transplant recipients with low estimated GFR, 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 higher likelihood of relisting or retransplantation within one year of graft failure.Study Design: Retrospective cohort study Setting & Participants: We included adults who developed graft failure between 2010-2021 according to US Renal Data System.Exposure: We modeled the time spent with eGFR between 20 and 5 mL/min/1.73m 2 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.Analytic Approach: We used Fine and Gray models accounting for the competing risk of death to determine the association between time 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, approximately 18% (n=2,690) of patients were relisted and 13% (n=1,854) were re-transplanted.In adjusted models, spending 2-4 years (SHR 1.43; 95% CI 1.16-1.75)or >4 years (SHR 1.28; 95% CI 1.04-1.57)with low eGFR was associated with 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 higher likelihood of retransplantation within one year of graft failure.