© 2002 SAGE Publications
Intercept and Slope Analysis of Risk Factors in Chronic Renal Allograft Nephropathy
In the Leiden cohort of cadaveric renal transplants, the authors compared the risk factors of a low intercept, defined as a creatinine clearance lower than 50 ml/min at 6 months, and of a negative slope of the reciprocal creatinine concentrations after 6 months. Two hundred of 654 grafts (31%) failed to reach optimal function because of old donor age, female gender of the donor, histoincompatibility, delayed graft function, or acute rejection episodes in the first 6 months. Forty-four percent of all grafts displayed progressive deterioration of function over time. The association with younger recipient age, sensitization, class I histoincompatibility, baseline immunosuppression, and late acute rejection episodes suggest an underlying immunological process, very likely activated through the indirect antigen-presenting route. The negative impact of proteinuria and diastolic hypertension at 6 months on the slope is compatible with their role as progression factors. Although associations are not necessarily causally related and interventions do not necessarily result in an improvement in outcome, it is conceivable that better matching, optimal immunosuppression, and a more aggressive antihypertensive and antiproteinuric treatment result in improvement of long-term graft survival.
Key Words: renal transplantation chronic rejection risk factors