Plasma FGF23 Concentrations During the First Six Months Following Renal Transplantation Do Not Predict Graft Survival, Overall Mortality or Cardiovascular Morbidity.

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Background and objectives High FGF23 concentrations are associated with an increased risk of cardiovascular events in CKD patients and with graft loss and cardiovascular and overall mortality after renal transplantation (RTx). However, the prognostic feature of plasma FGF23 before and over the first months of RTx remains unknown. Patients and methods 414 renal transplant recipients enrolled from January 1997 to February 2006 were followed prospectively for a median time of 8.8 years. The association between FGF23 concentrations (C-terminal), phosphate metabolism parameters, and graft survival, cardiovascular events and overall mortality was evaluated using Spearman correlation coefficient. Survival analyses were performed with the log-rank analysis and multivariate Cox models. Results Patients mean age was 45 ± 14 years, 62% were male. At the time of RTx, which occurred 26 (16-48) months after the start of dialysis, median FGF23 level was 4565 (1208-12734) RU/ml, median PTH was 203 (94-441) pg/ml and serum 25(OH) D3 was 29 ± 19 ng/ml. Six months after RTx, eGFR was 54 ± 21 ml/min/1.73 m2 and median FGF23 49 (31-78) RU/ml. At this time, plasma FGF23 concentration was negatively correlated with renal function, serum albumin and the use of mTOR inhibitor and positively with PTH, calcium urinary excretion and the use of tacrolimus. During follow-up, 71 patients (17.1%) lost their graft, 70 (16.9 %) had a cardiovascular event and 55 (13.3 %) died. Plasma FGF23 levels at RTx and 1 month later were not correlated with graft survival, cardiovascular risk and overall survival. We observed a significant correlation between FGF23 plasma levels and graft loss at 6 months (p = 0.02) but not with cardiovascular events and mortality. However, this correlation vanished after adjustment for kidney function in multivariate analysis. Conclusions FGF23 plasma levels at the time of RTx and 1 and 6 months later were not associated with kidney graft survival, cardiovascular events risk or mortality. These results suggest that FGF23 dosage performed early after RTx cannot be used as prognostic factor to assess long term transplantation outcomes.

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