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Change in Estimated GFR and Risk of Allograft Failure in Patients Diagnosed With Late Active Antibody-mediated Rejection Following Kidney Transplantation
- Source :
- Scientia, Transplantation
- Publication Year :
- 2021
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2021.
-
Abstract
- Malaltia renal en fase terminal; Trasplantament de ronyó Enfermedad renal en etapa terminal; Transplante de riñón End-stage renal disease; Kidney Transplant Background. There are challenges in designing adequate, well-controlled studies of patients with active antibody-mediated rejection (AMR) after kidney transplantation (KTx). Methods. We assessed the functional relationship between change in estimated glomerular filtration rate (eGFR) following the diagnosis of AMR and the risk of subsequent death-censored graft failure using the joint modeling framework. We included recipients of solitary KTx between 1995 and 2013 at 4 transplant centers diagnosed with biopsy-proven active AMR at least 1 year post-KTx, who had a minimum of 3-year follow-up. Results. A total of 91 patients across participating centers were included in the analysis. Of the 91 patients, n = 54 patients (59%) met the death-censored graft failure endpoint and n = 62 patients (68%) met the all-cause graft failure composite endpoint. Kaplan-Meier death-censored graft survival rates at 12, 36, and 60 months postdiagnosis of AMR pooled across centers were 88.9%, 58.9%, and 36.4%, respectively. Spaghetti plots indicated a linear trend in the change in eGFR, especially in the first 12 months postdiagnosis of active AMR. A significant change in eGFR was observed within the first 12 months postdiagnosis of active AMR, getting worse by a factor of −0.757 mL/min/1.73 m2 per month during the 12-month analysis period (a delta of −9.084 mL/min/1.73 m2 at 1 y). Notably, an extrapolated 30% improvement in the slope of eGFR in the first 12 months was associated with a 10% improvement in death-censored graft failure at 5 years. Conclusions. If prospectively validated, this study may inform the design of pivotal clinical trials for therapies for late AMR.
- Subjects :
- Adult
Graft Rejection
Male
medicine.medical_specialty
Time Factors
Allograft failure
Biopsy
Urology
Surgical Procedures, Operative::Transplantation::Organ Transplantation::Surgical Procedures, Operative::Kidney Transplantation [ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT]
Renal function
030230 surgery
Kidney
Otros calificadores::Otros calificadores::/efectos adversos [Otros calificadores]
Immune System Phenomena::Transplantation Immunology::Host vs Graft Reaction::Graft Rejection [PHENOMENA AND PROCESSES]
Article
03 medical and health sciences
0302 clinical medicine
Other subheadings::Other subheadings::/adverse effects [Other subheadings]
medicine
Humans
In patient
Kidney transplantation
Retrospective Studies
Transplantation
medicine.diagnostic_test
business.industry
Graft Survival
Retrospective cohort study
Allografts
medicine.disease
Kidney Transplantation
Clinical trial
Rebuig (Biologia)
intervenciones quirúrgicas::trasplante::trasplante de órganos::intervenciones quirúrgicas::trasplante de riñón [TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS]
Acute Disease
Female
030211 gastroenterology & hepatology
Graft survival
fenómenos del sistema inmunitario::inmunología del trasplante::reacción huésped contra injerto::rechazo del injerto [FENÓMENOS Y PROCESOS]
business
Ronyons - Trasplantació - Complicacions
Follow-Up Studies
Glomerular Filtration Rate
Subjects
Details
- ISSN :
- 00411337
- Volume :
- 105
- Database :
- OpenAIRE
- Journal :
- Transplantation
- Accession number :
- edsair.doi.dedup.....dc98d189b70280d39416ddc07a743536