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. 2023 Jun 1;4(6):e809-e816.
doi: 10.34067/KID.0000000000000154. Epub 2023 May 22.

Predicting Long-term Outcomes in Deceased Donor Kidney Transplant Recipients Using Three Short-term Graft Characteristics

Shaifali Sandal  1   2   3   4   5   6   7   8 , Marcelo Cantarovich  1   2   3   4   5   6   7   8 , Heloise Cardinal  5 , Agnihotram V Ramankumar  2 , Lynne Senecal  6 , Suzon Collette  6 , Chee Long Saw  3   7 , Steven Paraskevas  2   3   8 , Jean Tchervenkov  2   3   8
Affiliations

Predicting Long-term Outcomes in Deceased Donor Kidney Transplant Recipients Using Three Short-term Graft Characteristics

Shaifali Sandal et al. Kidney360. .

Abstract

Key Points:

  1. Delayed graft function is not an ideal measure of graft function, yet is used to assess risk in kidney transplantation.

  2. We propose a model that combines it with two other measures of 90-day graft function to identify recipients at incremental risk of inferior long-term outcomes.

Background: Delayed graft function (DGF) in kidney transplant recipients is used to determine graft prognosis, make organ utilization decisions, and as an important end point in clinical trials. However, DGF is not an ideal measure of graft function. We aimed to develop and validate a model that provides incremental risk assessment for inferior patient and graft outcomes.

Methods: We included adult kidney-only deceased donor transplant recipients from 1996 to 2016. In addition to DGF, two short-term measures were used to assess risk: renal function recovery <100% (attaining half the donor's eGFR) and recipient's 90-day eGFR <30. Recipients were at no, low, moderate, or high risk if they met zero, one, two, or all criteria, respectively. Cox proportional hazard models were used to assess the independent relationship between exposure and death-censored graft failure (DCGF) and mortality.

Results: Of the 792 eligible recipients, 24.5% experienced DGF, 40.5% had renal function recovery <100%, and 6.9% had eGFR <30. Over a median follow-up of 7.3 years, the rate of DCGF was 18.7% and mortality was 25.1%. When compared with recipients at no risk, those at low, moderate, and high risk were noted to have an increase in risk of DCGF (adjusted hazard ratio [aHR], 1.53; 95% confidence interval [CI], 1.03 to 2.27; aHR, 2.84; 95% CI, 1.68 to 4.79; aHR, 15.46; 95% CI, 8.04 to 29.71) and mortality (aHR, 1.16; 95% CI, 0.84 to 1.58; aHR, 1.85; 95% CI, 1.13 to 3.07; aHR, 2.66; 95% CI, 1.19 to 5.97). When using a hierarchical approach, each additional exposure predicted the risk of DCGF better than DGF alone and 100 random bootstrap replications supported the internal validity of the risk model. In an external validation cohort deemed to be at lower risk of DCGF, similar nonsignificant trends were noted.

Conclusion: We propose a risk model that provides an incremental assessment of recipients at higher risk of adverse long-term outcomes than DGF alone. This can help advance the field of risk assessment in transplantation and inform therapeutic decision making in patients at the highest spectrum of inferior outcomes.

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Conflict of interest statement

H. Cardinal reports the following: Research Funding: Astellas provided funding of $50,000 per year for the maintenance of the kidney transplant biobank at the Centre Hospitalier de l'Université de Montreal. This funding was stopped in 2021. This biobank is one of the Canadian Donation and Transplantation Research Program–affiliated biobanks. S. Collette reports the following: Research Funding: Medeor Therapeutics, Vera Therapeutics; and Honoraria: Takeda. S. Sandal reports the following: Research Funding: An education grant from Amgen Canada. J. Tchervenkov reports the following: Ownership Interest: Apple; Gilead; Microsoft; Research Funding: Astellas Canada; and Patents or Royalties: 11949018 Canada Inc. All remaining authors have nothing to disclose.

Figures

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Graphical abstract
Figure 1
Figure 1
Study flow diagram.
See this image and copyright information in PMC

References

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