Dataset Information

Progression of Kidney Disease in Kidney Transplant Recipients With a Failing Graft: A Matched Cohort Study.

ABSTRACT:

Background

Few studies have assessed outcomes in transplant recipients with failing grafts as most studies have focused on outcomes after graft loss.

Objective

To determine whether renal function declines faster in kidney transplant recipients with a failing graft than in people with chronic kidney disease of their native kidneys.

Design

Retrospective cohort study.

Setting

Alberta, Canada (2002-2019).

Patients

We identified kidney transplant recipients with a failing graft (2 estimated glomerular filtration rate [eGFR] measurements 15-30 mL/min/1.73 m² ≥90 days apart).

Measurements

We compared the change in eGFR over time (eGFR with 95% confidence limits, _LCLeGFR_UCL) and the competing risks of kidney failure and death (cause-specific hazard ratios [HRs], _LCLHR_UCL).

Methods

Recipients (n = 575) were compared with propensity-score-matched, nontransplant controls (n = 575) with a similar degree of kidney dysfunction.

Results

The median potential follow-up time was 7.8 years (interquartile range, 3.6-12.1). The hazards for kidney failure (HR_1.101.33_1.60) and death (HR_1.211.59_2.07) were significantly higher for recipients, while the eGFR decline over time was similar (recipients vs controls: _-2.60-2.27_-1.94 vs _-2.52-2.21_-1.90 mL/min/1.73 m² per year). The rate of eGFR decline was associated with kidney failure but not death.

Limitations

This was a retrospective, observational study, and there is a risk of bias due to residual confounding.

Conclusions

Although eGFR declines at a similar rate in transplant recipients as in nontransplant controls, recipients have a higher risk of kidney failure and death. Studies are needed to identify preventive measures to improve outcomes in transplant recipients with a failing graft.

SUBMITTER: Lam NN

PROVIDER: S-EPMC10259097 | biostudies-literature | 2023

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Progression of Kidney Disease in Kidney Transplant Recipients With a Failing Graft: A Matched Cohort Study.

Lam Ngan N NN Quinn Robert R RR Clarke Alix A Al-Wahsh Huda H Knoll Greg A GA Tibbles Lee Anne LA Kamar Fareed F Jeong Rachel R Kiberd James J Ravani Pietro P

Canadian journal of kidney health and disease 20230601

<h4>Background</h4>Few studies have assessed outcomes in transplant recipients with failing grafts as most studies have focused on outcomes after graft loss.<h4>Objective</h4>To determine whether renal function declines faster in kidney transplant recipients with a failing graft than in people with chronic kidney disease of their native kidneys.<h4>Design</h4>Retrospective cohort study.<h4>Setting</h4>Alberta, Canada (2002-2019).<h4>Patients</h4>We identified kidney transplant recipients with a ...[more]

PMID: 37313362

Similar Datasets

Project description:BackgroundGraft 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.MethodsWe 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.ResultsFor 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.ConclusionThe 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.

Dataset Information

Progression of Kidney Disease in Kidney Transplant Recipients With a Failing Graft: A Matched Cohort Study.

Background

Objective

Design

Setting

Patients

Measurements

Methods

Results

Limitations

Conclusions

Publications

Progression of Kidney Disease in Kidney Transplant Recipients With a Failing Graft: A Matched Cohort Study.

Similar Datasets

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