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Background: We compared effects of immunosuppression and co-morbidities on kidney function following renal transplant.Methods: We perfomed retrospective chart review in 211 consecutive renal transplant recipients, treated at a single medical center between 2004 to 2014, who also underwent a post-transplant echocardiogram. Patients were stratified into ESRD/CKD-4 group and CKD1-3 according to standard GFR criteria. The study was approved by IRB.Results: Average age was 52.4 +/- 11.8 years old, 41% were females, 95% with history HTN, 81% with dislipidemia, 20% with CAD, 42% with diabetes mellitus, 26% past smokers, 16% on thyroid replacement therapy, 8% with history of congestive heart failure. The average hemoglobin was 11.9 +/- 2.2 mg/dL. Sixty percent of patients were on triple immunosuppressive therapy. In our study cohort, with an average time post-kidney transplant of 41.7+/-34.8 months, 26.5% patients had ESRD/CKD-4. Female gender (OR 2.26, 95% CI 1.21-4.20; p=0.01), diabetes mellitus (OR 0.502, 95% CI 0.26-0.96; p=0.03), triple immunosuppressive therapy (OR 0.279, CI 0.15-0.23; p<0.0001), and hemoglobin (OR 0.632, 95% CI 0.53-0.76; p<0.0001) were significant independent predictors of post-kidney transplant GFR. In multivariable regression analysis, post-transplant hemoglobin (OR 0.641, 95% CI 0.53-0.77; p<0.0001) and triple immunosuppressive therapy (OR 0.282, CI 0.15-0.53; p=0.0004) were significant predictors of preserved GFR and lower CKD category.Conclusions: Higher Hgb levels and triple immune-suppressive therapy are associated with improved kidney function post-renal transplant. Additional studies are needed to identify causes of decreased hemoglobin in this patient population and to develop treatment strategies aimed at preserving GFR.