{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,31]],"date-time":"2026-10-31T17:39:26Z","timestamp":1793468366658,"version":"4.5.0"},"reference-count":25,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2023,9,23]],"date-time":"2023-09-23T00:00:00Z","timestamp":1695427200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Transplantation"],"published-print":{"date-parts":[[2023,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>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\u2010up and examine its correlation with graft survival.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We calculated eGFR using all creatinine values available from 1\u2010year post transplantation to the end of follow\u2010up. For pattern analysis, we used a piecewise linear model.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Nine hundred eighty\u2010eight patients were included in the study. After a median follow\u2010up of 5.2 years, 297 (30.1%) patients had a multi\u2010phasic eGFR trajectory. Change in eGFR trajectory was associated with increased risk for graft failure (HR 7.15, 95% CI 5.17\u20139.89, <jats:italic>p<\/jats:italic>\u00a0&lt;\u00a0.001), longer follow\u2010up 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\u2010phasic stable trajectory, 197 (19.9%) had a mono\u2010phasic decreasing trajectory, 184 (18.6%) had bi\u2010phasic decreasing trajectory (initial stability and then decline, 46(4.7%) had a bi\u2010phasic stabilized (initial decline and then stabilization) and 67(6.8%) had a more complex trajectory (tri\u2010phasic). Out of the total 144 patients who experienced graft loss, the predominant pattern was a bi\u2010phasic decline characterized by a bi\u2010linear trajectory (66 events, 45.8%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Changes in eGFR trajectory during long\u2010term follow\u2010up can serve as a valuable tool for assessing the underlying mechanisms contributing to graft loss.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ctr.15129","type":"journal-article","created":{"date-parts":[[2023,9,24]],"date-time":"2023-09-24T06:33:42Z","timestamp":1695537222000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Multi\u2010phasic eGFR trajectory during follow up and long\u2010term graft failure after kidney transplantation"],"prefix":"10.1111","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1346-3771","authenticated-orcid":false,"given":"Ruth","family":"Rahamimov","sequence":"first","affiliation":[{"name":"Department of Nephrology and Hypertension Rabin Medical Center Beilinson Campus  Petah\u2010Tikva Israel"},{"name":"Department of Transplantation Rabin Medical Center Beilinson Campus  Petah\u2010Tikva Israel"},{"name":"Sackler Faculty of Medicine Tel\u2010Aviv University  Tel\u2010Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8263-0900","authenticated-orcid":false,"given":"Timna","family":"Agur","sequence":"additional","affiliation":[{"name":"Department of Nephrology and Hypertension Rabin Medical Center Beilinson Campus  Petah\u2010Tikva Israel"},{"name":"Sackler Faculty of Medicine Tel\u2010Aviv University  Tel\u2010Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Boris","family":"Zingerman","sequence":"additional","affiliation":[{"name":"Department of Nephrology and Hypertension Rabin Medical Center Beilinson Campus  Petah\u2010Tikva Israel"},{"name":"Sackler Faculty of Medicine Tel\u2010Aviv University  Tel\u2010Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9476-0032","authenticated-orcid":false,"given":"Dana","family":"Bielopolski","sequence":"additional","affiliation":[{"name":"Department of Nephrology and Hypertension Rabin Medical Center Beilinson Campus  Petah\u2010Tikva Israel"},{"name":"Sackler Faculty of Medicine Tel\u2010Aviv University  Tel\u2010Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tali","family":"Steinmetz","sequence":"additional","affiliation":[{"name":"Department of Nephrology and Hypertension Rabin Medical Center Beilinson Campus  Petah\u2010Tikva Israel"},{"name":"Sackler Faculty of Medicine Tel\u2010Aviv University  Tel\u2010Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eviatar","family":"Nesher","sequence":"additional","affiliation":[{"name":"Department of Transplantation Rabin Medical Center Beilinson Campus  Petah\u2010Tikva Israel"},{"name":"Sackler Faculty of Medicine Tel\u2010Aviv University  Tel\u2010Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iddo","family":"Hanniel","sequence":"additional","affiliation":[{"name":"MobilEye Vision Technologies INC  Petah\u2010Tikva Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benaya","family":"Rozen\u2010Zvi","sequence":"additional","affiliation":[{"name":"Department of Nephrology and Hypertension Rabin Medical Center Beilinson Campus  Petah\u2010Tikva Israel"},{"name":"Sackler Faculty of Medicine Tel\u2010Aviv University  Tel\u2010Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,9,23]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(76)91974-7"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.ASN.0000070621.06264.86"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-6143.2005.00853.x"},{"issue":"2","key":"e_1_2_8_5_1","first-page":"ii2","article-title":"Long\u2010term graft function changes in kidney transplant recipients","volume":"3","author":"Marcen R","year":"2010","journal-title":"NDT Plus"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.l4923"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1038\/ki.1997.260"},{"key":"e_1_2_8_8_1","first-page":"1737","article-title":"Multi\u2010trajectory models of chronic kidney disease progression","volume":"2016","author":"Burckhardt P","year":"2016","journal-title":"AMIA Annu Symp Proc"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2011.12.009"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0000000000000377"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1159\/000453076"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.kint.2020.07.025"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/00007890-199911150-00017"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/ctr.14962"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm10071484"},{"issue":"2","key":"e_1_2_8_16_1","first-page":"393","article-title":"Association of the combination of time\u2010weighted variability of tacrolimus blood level and exposure to low drug levels with graft survival after kidney transplantation","volume":"32","author":"Rozen\u2010Zvi B","year":"2017","journal-title":"Nephrol Dial Transplant"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-150-9-200905050-00006"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.kint.2018.08.026"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc13-0985"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1159\/000320749"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1177\/2054358116679129"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2017.10.023"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0149283"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2011.11.044"},{"key":"e_1_2_8_25_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40620-020-00793-2"},{"key":"e_1_2_8_26_1","doi-asserted-by":"publisher","DOI":"10.1111\/ctr.13398"}],"container-title":["Clinical Transplantation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ctr.15129","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,1,10]],"date-time":"2024-01-10T14:52:43Z","timestamp":1704898363000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/ctr.15129"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,9,23]]},"references-count":25,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2023,12]]}},"alternative-id":["10.1111\/ctr.15129"],"URL":"https:\/\/doi.org\/10.1111\/ctr.15129","archive":["Portico"],"relation":{},"ISSN":["0902-0063","1399-0012"],"issn-type":[{"value":"0902-0063","type":"print"},{"value":"1399-0012","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,9,23]]},"assertion":[{"value":"2023-02-04","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-09-01","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-09-23","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e15129"}}