Multi-phasic eGFR trajectory during follow up and long-term graft failure after kidney transplantation

Ruth Rahamimov*, Timna Agur, Boris Zingerman, Dana Bielopolski, Tali Steinmetz, Eviatar Nesher, Iddo Hanniel, Benaya Rozen-Zvi

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background: The prevailing assumption is that following kidney transplantation the pattern of kidney function decline is consistent. Nevertheless, numerous factors leading to graft loss may emerge, altering the trajectory of kidney function. In this study, we aim to assess alterations in estimated glomerular filtration rate (eGFR) trajectory over an extended period of follow-up and examine its correlation with graft survival. Methods: We calculated eGFR using all creatinine values available from 1-year post transplantation to the end of follow-up. For pattern analysis, we used a piecewise linear model. Results: Nine hundred eighty-eight patients were included in the study. After a median follow-up of 5.2 years, 297 (30.1%) patients had a multi-phasic eGFR trajectory. Change in eGFR trajectory was associated with increased risk for graft failure (HR 7.15, 95% CI 5.17–9.89, p <.001), longer follow-up time, younger age, longer cold ischemia time, high prevalence of acute rejection, longer hospitalization and a lower initial eGFR. Of the 988 patients included in the study, 494 (50.0%) had a mono-phasic stable trajectory, 197 (19.9%) had a mono-phasic decreasing trajectory, 184 (18.6%) had bi-phasic decreasing trajectory (initial stability and then decline, 46(4.7%) had a bi-phasic stabilized (initial decline and then stabilization) and 67(6.8%) had a more complex trajectory (tri-phasic). Out of the total 144 patients who experienced graft loss, the predominant pattern was a bi-phasic decline characterized by a bi-linear trajectory (66 events, 45.8%). Conclusions: Changes in eGFR trajectory during long-term follow-up can serve as a valuable tool for assessing the underlying mechanisms contributing to graft loss.

Original languageEnglish
Article numbere15129
JournalClinical Transplantation
Issue number12
StatePublished - Dec 2023


  • eGFR progression patterns
  • eGFR trajectory patterns
  • graft failure
  • graft survival
  • kidney transplantation


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