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Yao Y, Astor BC, Yang W, Greene T, Li L. Predicting kidney graft function and failure among kidney transplant recipients. BMC Med Res Methodol 2024; 24:324. [PMID: 39736573 DOI: 10.1186/s12874-024-02445-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 12/16/2024] [Indexed: 01/01/2025] Open
Abstract
BACKGROUND Graft loss is a major health concern for kidney transplant (KTx) recipients. It is of clinical interest to develop a prognostic model for both graft function, quantified by estimated glomerular filtration rate (eGFR), and the risk of graft failure. Additionally, the model should be dynamic in the sense that it adapts to accumulating longitudinal information, including time-varying at-risk population, predictor-outcome association, and clinical history. Finally, the model should also properly account for the competing risk by death with a functioning graft. A model with the features above is not yet available in the literature and is the focus of this research. METHODS We built and internally validated a prediction model on 3,893 patients from the Wisconsin Allograft Recipient Database (WisARD) who had a functioning graft 6 months after kidney transplantation. The landmark analysis approach was used to build a proof-of-concept dynamic prediction model to address the aforementioned methodological issues: the prediction of graft failure, accounted for competing risk of death, as well as the future eGFR value, are updated at each post-transplant time. We used 21 predictors including recipient characteristics, donor characteristics, transplant-related and post-transplant factors, longitudinal eGFR, hospitalization, and rejection history. A sensitivity analysis explored a less conservative variable selection rule that resulted in a more parsimonious model with reduced predictors. RESULTS For prediction up to the next 1 to 5 years, the model achieved high accuracy in predicting graft failure, with the AUC between 0.80 and 0.95, and moderately high accuracy in predicting eGFR, with the root mean squared error between 10 and 18 mL/min/1.73m2 and 70%-90% of predicted eGFR falling within 30% of the observed eGFR. The model demonstrated substantial accuracy improvement compared to a conventional prediction model that used only baseline predictors. CONCLUSION The model outperformed conventional prediction model that used only baseline predictors. It is a useful tool for patient counseling and clinical management of KTx and is currently available as a web app.
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Affiliation(s)
- Yi Yao
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Brad C Astor
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Wei Yang
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Tom Greene
- School of Medicine, University of Utah, Madison, UT, USA
| | - Liang Li
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Chong HJ, Jang MK, Kim HK. Cardiovascular risk trajectory and its associated factors among candidates on the waiting list for deceased-donor kidney transplantation: A longitudinal study. Heart Lung 2024; 63:114-118. [PMID: 37871518 DOI: 10.1016/j.hrtlng.2023.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 05/30/2023] [Accepted: 10/15/2023] [Indexed: 10/25/2023]
Abstract
BACKGROUND Cardiovascular disease is a significant cause of morbidity and mortality for wait-listed kidney transplant candidates. Since cardiovascular risk is related to a variety of factors and may change with time, longitudinal changes in cardiovascular risk and related factors in candidates need to be investigated. OBJECTIVES This study aimed to examine the trajectory of the cardiovascular risk score and its related factors in patients on the waiting list for deceased-donor kidney transplantation (DDKT). METHODS This longitudinal study enrolled 144 patients who were registered as candidates for a DDKT at a transplant center in South Korea. During the 5-year follow-up period, 3 candidates on the waiting list were transferred to other hospitals, 19 candidates died, and 31 candidates received kidney transplantation. RESULTS Approximately 26.6 % of the candidates had a high level of cardiovascular risk, and this increased to 53.2 % after 5 years. A high risk of psychosocial status (β=0.351, p=.026) was the most significant predictor of cardiovascular risk, followed by higher comorbidity (β=0.263, p<.001). Comorbidities were a significant factor associated with cardiovascular risk throughout the 5-year period, whereas the duration of dialysis and waiting time were significant only within 1 year after baseline. CONCLUSION Cardiovascular risk during 5 years on the waiting list for DDKT was associated with multidimensional factors, including psychosocial status before transplantation, comorbidity, waiting time for transplantation, and the duration of dialysis. In addition to managing comorbid conditions, shortening the waiting time and duration of dialysis is important for reducing cardiovascular risk during the long-term care of candidates on the waiting list for DDKT.
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Affiliation(s)
- Hye Jin Chong
- Department of Nursing, Sunchon National University, Jeolanam-do, Republic of Korea; Research Institute of Nursing Science, Jeonbuk National University, Jeonju, Republic of Korea
| | - Min Kyeong Jang
- Mo-Im Kim Nursing Research Institute, Yonsei University College of Nursing, Seoul, Republic of Korea
| | - Hyun Kyung Kim
- Research Institute of Nursing Science, Jeonbuk National University, Jeonju, Republic of Korea; College of Nursing, Jeonbuk National University, Jeonju, Republic of Korea.
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Masoumi N, Ghaffari M, Asgari MA, Dadpour M. Comparison of the Charlson comorbidity index, the modified Charlson comorbidity index, and the recipient risk score in prediction of the graft and patient survival among renal graft recipients: historical cohort in a single center. Int Urol Nephrol 2023; 55:2447-2456. [PMID: 37368085 DOI: 10.1007/s11255-023-03670-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 06/08/2023] [Indexed: 06/28/2023]
Abstract
OBJECTIVE To compare the predictive values of Charlson comorbidity index (CCI), modified Charlson comorbidity index kidney transplant (mCCI-KT) and recipient risk score (RRS) indices in prediction of patient and graft survival in kidney transplant patients. METHODS In this retrospective study, all patients who underwent a live-donor KT from 2006 to 2010, were included. Demographic data, comorbidities and survival time after KT were extracted and the association between above indices with patient and graft survival were compared. RESULTS In ROC curve analysis of 715 included patients, all three indicators were weak in predicting graft rejection with the area under curve (AUC) less than 0.6. The best models for predicting the overall survival were mCCI-KT and CCI with AUC of 0.827 and 0.780, respectively. Sensitivity and specificity of mCCI-KT at cut point of 1 were 87.2 and 75.6. Sensitivity and specificity of CCI at cut point of 3 were 84.6 and 68.3 and for RRS at cut point of 3 were 51.3 and 81.2, respectively. CONCLUSION The mCCI-KT index followed by the CCI index provided the best model in predicting the 10-year patient survival; however, they were poor in predicting graft survival and this model can be used for better stratifying transplant candidates prior to surgery.
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Affiliation(s)
- Navid Masoumi
- Department of Urology, Shahid Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Majed Ghaffari
- Urology-Nephrology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Majid Ali Asgari
- Urology-Nephrology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Dadpour
- Urology and Nephrology Research Center, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, 9th Boostan, Pasdaran Avenue, Tehran, 1666663111, Iran.
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Initial experience with minimal incision dual kidney transplantation. Am J Surg 2021; 221:913-917. [DOI: 10.1016/j.amjsurg.2020.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 10/11/2020] [Accepted: 11/01/2020] [Indexed: 12/14/2022]
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Sullivan MK, Rankin AJ, Jani BD, Mair FS, Mark PB. Associations between multimorbidity and adverse clinical outcomes in patients with chronic kidney disease: a systematic review and meta-analysis. BMJ Open 2020; 10:e038401. [PMID: 32606067 PMCID: PMC7328898 DOI: 10.1136/bmjopen-2020-038401] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 06/01/2020] [Accepted: 06/02/2020] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE To systematically review the literature exploring the associations between multimorbidity (the presence of two or more long-term conditions (LTCs)) and adverse clinical outcomes in patients with chronic kidney disease (CKD). DESIGN Systematic review and meta-analysis. DATA SOURCES MEDLINE, EMBASE, CINAHL, Cochrane Library and SCOPUS (1946-2019). The main search terms were 'Chronic Kidney Failure' and 'Multimorbid*'. ELIGIBILITY CRITERIA Observational studies of adults over the age of 18 with CKD stages 3-5, that is, estimated glomerular filtration rate less than 60 mL/min/1.73 m2. The exposure was multimorbidity quantified by measures and the outcomes were all-cause mortality, renal progression, hospitalisation and cardiovascular events. We did not consider CKD as a comorbid LTC. DATA EXTRACTION AND SYNTHESIS Newcastle-Ottawa Scale for quality appraisal and risk of bias assessment and fixed effects meta-analysis for data synthesis. RESULTS Of 1852 papers identified, 26 met the inclusion criteria. 21 papers involved patients with advanced CKD and no studies were from low or middle-income countries. All-cause mortality was an outcome in all studies. Patients with multimorbidity were at higher risk of mortality compared with patients without multimorbidity (total risk ratio 2.28 (95% CI 1.81 to 2.88)). The risk of mortality was higher with increasing multimorbidity (total HR 1.31 (95% CI 1.27 to 1.36)) and both concordant and discordant LTCs were associated with heightened risk. Multimorbidity was associated with renal progression in four studies, hospitalisation in five studies and cardiovascular events in two studies. LIMITATIONS Meta-analysis could only include 10 of 26 papers as the methodologies of studies were heterogeneous. CONCLUSIONS There are associations between multimorbidity and adverse clinical outcomes in patients with CKD. However, most data relate to mortality risk in patients with advanced CKD. There is limited evidence regarding patients with mild to moderate CKD, outcomes such as cardiovascular events, types of LTCs and regarding patients from low or middle-income countries. PROSPERO REGISTRATION NUMBER CRD42019147424.
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Affiliation(s)
- Michael K Sullivan
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Alastair J Rankin
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Bhautesh D Jani
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Frances S Mair
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Patrick B Mark
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
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Chan EY, Nguyen DT, Kaleekal TS, Goodarzi A, Graviss EA, Gaber AO, Sinha N, Suarez EE, Bruckner BA, MacGillivray TE, Huang HJ, Yau SW. The Houston Methodist Lung Transplant Risk Model: A Validated Tool for Pretransplant Risk Assessment. Ann Thorac Surg 2019; 108:1094-1100. [DOI: 10.1016/j.athoracsur.2019.03.108] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 03/25/2019] [Accepted: 03/26/2019] [Indexed: 10/26/2022]
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Schwager Y, Littbarski SA, Nolte A, Kaltenborn A, Emmanouilidis N, Kleine-Döpke D, Klempnauer J, Schrem H. Prediction of Three-Year Mortality After Deceased Donor Kidney Transplantation in Adults with Pre-Transplant Donor and Recipient Variables. Ann Transplant 2019; 24:273-290. [PMID: 31097680 PMCID: PMC6540619 DOI: 10.12659/aot.913217] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Prognostic models for 3-year mortality after kidney transplantation based on pre-transplant donor and recipient variables may avoid futility and thus improve donor organ allocation. Material/Methods There were 1546 consecutive deceased-donor kidney transplants in adults (January 1, 2000 to December 31, 2012) used to identify pre-transplant donor and recipient variables with significant independent influence on long-term survival (Cox regression modelling). Detected factors were used to develop a prognostic model for 3-year mortality in 1289 patients with follow-up of >3 years (multivariable logistic regression). The sensitivity and specificity of this model’s prognostic ability was assessed with the area under the receiver operating characteristic curve (AUROC). Results Highly immunized recipients [hazard ratio (HR: 2.579, 95% CI: 1.272–4.631], high urgency recipients (HR: 3.062, 95% CI: 1.294–6.082), recipients with diabetic nephropathy (HR: 3.471, 95% CI: 2.476–4.751), as well as 0, 1, or 2 HLA DR mismatches (HR: 1.349, 95% CI: 1.160–1.569) were independent and significant risk factors for patient survival. Younger recipient age ≤42.1 years (HR: 0.137, 95% CI: 0.090–0.203), recipient age 42.2–52.8 years (HR: 0.374, 95% CI: 0.278–0.498), recipient age 52.9–62.8 years (HR: 0.553, 95% CI: 0.421–0.723), short cold ischemic times ≤11.8 hours (HR: 0.602, 95% CI: 0.438–0.814) and cold ischemic times 11.9–15.3 hours (HR: 0.736, 95% CI: 0.557–0.962) reduced this risk independently and significantly. The AUROC of the derived model for 3-year post-transplant mortality with these variables was 0.748 (95% CI: 0.689–0.788). Conclusions Older, highly immunized or high urgency transplant candidates with anticipated longer cold ischemic times, who were transplanted with the indication of diabetic nephropathy should receive donor organs with no HLA DR mismatches to improve their mortality risk.
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Affiliation(s)
- Ysabell Schwager
- Core Facility Quality Management and Health Technology Assessment in Transplantation, Integrated Research and Treatment Facility Transplantation (IFB-Tx), Hannover Medical School, Hannover, Germany
| | - Simon Alexander Littbarski
- Core Facility Quality Management and Health Technology Assessment in Transplantation, Integrated Research and Treatment Facility Transplantation (IFB-Tx), Hannover Medical School, Hannover, Germany
| | - Almut Nolte
- Core Facility Quality Management and Health Technology Assessment in Transplantation, Integrated Research and Treatment Facility Transplantation (IFB-Tx), Hannover Medical School, Hannover, Germany
| | - Alexander Kaltenborn
- Core Facility Quality Management and Health Technology Assessment in Transplantation, Integrated Research and Treatment Facility Transplantation (IFB-Tx), Hannover Medical School, Hannover, Germany
| | - Nikos Emmanouilidis
- Department of General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany
| | - Dennis Kleine-Döpke
- Department of General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany
| | - Jürgen Klempnauer
- Department of General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany
| | - Harald Schrem
- Core Facility Quality Management and Health Technology Assessment in Transplantation, Integrated Research and Treatment Facility Transplantation (IFB-Tx), Hannover Medical School, Hannover, Germany.,Department of General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany.,Department of General, Visceral and Transplant Surgery, Medical University of Graz, Graz, Austria
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Smith NK, Zerillo J, Schlichting N, Sakai T. Abdominal Organ Transplantation: Noteworthy Literature in 2018. Semin Cardiothorac Vasc Anesth 2019; 23:188-204. [DOI: 10.1177/1089253219842655] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
A PubMed search revealed 1382 articles on pancreatic transplantation, 781 on intestinal transplantation, more than 7200 on kidney transplantation, and more than 5500 on liver transplantation published between January 1, 2018, and December 31, 2018. After narrowing the list down to human studies, 436 pancreatic, 302 intestinal, 1920 liver, and more than 2000 kidney transplantation studies were screened for inclusion in this review.
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Affiliation(s)
- Natalie K. Smith
- The Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Jeron Zerillo
- The Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | | | - Tetsuro Sakai
- University of Pittsburgh Medical Center Health System, PA, USA
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Comorbidities Can Predict Mortality of Kidney Transplant Recipients: Comparison With the Charlson Comorbidity Index. Transplant Proc 2018; 50:1068-1073. [PMID: 29731067 DOI: 10.1016/j.transproceed.2018.01.044] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 01/22/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Comorbid conditions are important in the survival of kidney transplant recipients. The weights assigned to comorbidities to predict survival may vary based on the type of index disease and advances in the management of comorbidities. We aimed to develop a modified Charlson comorbidity index (CCI) in renal allograft recipients (mCCI-KT), thereby improving risk stratification for mortality. METHODS A total of 3765 recipients in a multicenter cohort were included to develop a comorbidity score. The weights of the comorbidities, per the CCI, were recalibrated using a Cox proportional hazards model. RESULTS Peripheral vascular disease, liver disease, myocardial infarction, and diabetes in the CCI were selected from the Cox proportional hazards model. Thus, the mCCI-KT included 4 comorbidities with recalibrated severity weights. Whereas the CCI did not discriminate for survival, the mCCI-KT provided significant discrimination for survival using the Kaplan-Meier method and Cox regression analysis. The mCCI-KT showed modest increases in c-statistics (0.54 vs 0.52, P = .001) and improved net mortality risk reclassification by 16.3% (95% confidence interval, 3.2-29.4; P = .015) relative to the CCI. CONCLUSION The mCCI-KT stratifies the risk for mortality in renal allograft recipients better than the CCI, suggesting that it may be a preferred index for use in clinical practice.
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Varotti G, Dodi F, Terulla A, Santori G, Mariottini G, Bertocchi M, Marchese A, Fontana I. Impact of carbapenem-resistant Klebsiella pneumoniae (CR-KP) infections in kidney transplantation. Transpl Infect Dis 2017; 19. [PMID: 28796391 DOI: 10.1111/tid.12757] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 04/23/2017] [Accepted: 05/18/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Carbapenem-resistant Klebsiella pneumoniae (CR-KP) infections in solid organ transplant patients are progressively increasing and are associated with worse outcomes, although potential risk factors and therapeutic strategies are still not well defined. METHODS We conducted a retrospective matched-pair analysis in which we compared 26 recipients CR-KP-positive after kidney transplantation (KT) with 52 CR-KP-negative patients transplanted in the same period, during a CR-KP outbreak that occurred in our hospital. Twenty-one patients (80%) received a combined antibiotic treatment. At the end of the follow-up, of the 26 CR-KP infected patients, 11 (42.3%) experienced at least one episode of re-infection, 9 (34.6%) remained colonized, and 6 (23.0%) had a symptomatic infection. Two of the 11 patients with re-infection died, while 9 were colonized at the end of the study. RESULTS A significantly better patient (P = .043) and graft (P < .001) survival was observed in CR-KP-negative patients. Univariate analysis identified the following variables as potential risk factors associated with CR-KP infection after KT: lower body mass index (P = .020); higher creatinine levels at post-transplant days 7 (P = .009), 15 (P = .026), and 30 (P = .019); longer hospital stay (P = .007); longer cold ischemia time (P = .004); delayed graft function (P = .020); and higher Clavien-Dindo score (P = .006). CONCLUSION The study confirmed that a CR-KP positivity may affect the outcome of a kidney transplant population. In severe CR-KP infections with sepsis, a combined antibiotic treatment seems to be advisable.
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Affiliation(s)
- Giovanni Varotti
- Kidney Transplant Unit, IRCCS San Martino University Hospital - IST National Institute for Cancer Research, Genoa, Italy
| | - Ferdinando Dodi
- Department of Infectious Disease, IRCCS San Martino University Hospital - IST National Institute for Cancer Research, Genoa, Italy
| | - Alessia Terulla
- Kidney Transplant Unit, IRCCS San Martino University Hospital - IST National Institute for Cancer Research, Genoa, Italy
| | - Gregorio Santori
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Gabriele Mariottini
- Kidney Transplant Unit, IRCCS San Martino University Hospital - IST National Institute for Cancer Research, Genoa, Italy
| | - Massimo Bertocchi
- Kidney Transplant Unit, IRCCS San Martino University Hospital - IST National Institute for Cancer Research, Genoa, Italy
| | - Anna Marchese
- Department of Microbiology, IRCCS San Martino University Hospital - IST National Institute for Cancer Research, Genoa, Italy
| | - Iris Fontana
- Kidney Transplant Unit, IRCCS San Martino University Hospital - IST National Institute for Cancer Research, Genoa, Italy
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