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: 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 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.