TY - JOUR
T1 - Death with function and graft failure after kidney transplantation
T2 - Risk factors at baseline suggest new approaches to management
AU - Merzkani, Massini A.
AU - Bentall, Andrew J.
AU - Smith, Byron H.
AU - Lopez, Xiomara Benavides
AU - D’Costa, Matthew R.
AU - Park, Walter D.
AU - Kremers, Walter K.
AU - Issa, Naim
AU - Rule, Andrew D.
AU - Chakkera, Harini
AU - Reddy, Kunam
AU - Khamash, Hasan
AU - Wadei, Hani M.
AU - Mai, Martin
AU - Alexander, Mariam P.
AU - Amer, Hatem
AU - Kukla, Aleksandra
AU - El Ters, Mireille
AU - Schinstock, Carrie A.
AU - Gandhi, Manish J.
AU - Heilman, Raymond
AU - Stegall, Mark D.
N1 - Publisher Copyright:
Copyright © 2022 The Author(s).
PY - 2022/1/13
Y1 - 2022/1/13
N2 - Background. Improving both patient and graft survival after kidney transplantation are major unmet needs. The goal of this study was to assess risk factors for specific causes of graft loss to determine to what extent patients who develop either death with a functioning graft (DWFG) or graft failure (GF) have similar baseline risk factors for graft loss. Methods. We retrospectively studied all solitary renal transplants performed between January 1, 2006, and December 31, 2018, at 3 centers and determined the specific causes of DWFG and GF. We examined outcomes in different subgroups using competing risk estimates and cause-specific Cox models. Results. Of the 5752 kidney transplants, graft loss occurred in 21.6% (1244) patients, including 12.0% (691) DWFG and 9.6% (553) GF. DWFG was most commonly due to malignancy (20.0%), infection (19.7%), cardiac disease (12.6%) with risk factors of older age and pretransplant dialysis, and diabetes as the cause of renal failure. For GF, alloimmunity (38.7%), glomerular diseases (18.6%), and tubular injury (13.9%) were the major causes. Competing risk incidence models identified diabetes and older recipients with higher rates of both DWFG and nonalloimmune GF. Conclusions. These data suggest that at baseline, 2 distinct populations can be identified who are at high risk for renal allograft loss: a younger, nondiabetic patient group who develops GF due to alloimmunity and an older, more commonly diabetic population who develops DWFG and GF due to a mixture of causes—many nonalloimmune. Individualized management is needed to improve long-term renal allograft survival in the latter group.
AB - Background. Improving both patient and graft survival after kidney transplantation are major unmet needs. The goal of this study was to assess risk factors for specific causes of graft loss to determine to what extent patients who develop either death with a functioning graft (DWFG) or graft failure (GF) have similar baseline risk factors for graft loss. Methods. We retrospectively studied all solitary renal transplants performed between January 1, 2006, and December 31, 2018, at 3 centers and determined the specific causes of DWFG and GF. We examined outcomes in different subgroups using competing risk estimates and cause-specific Cox models. Results. Of the 5752 kidney transplants, graft loss occurred in 21.6% (1244) patients, including 12.0% (691) DWFG and 9.6% (553) GF. DWFG was most commonly due to malignancy (20.0%), infection (19.7%), cardiac disease (12.6%) with risk factors of older age and pretransplant dialysis, and diabetes as the cause of renal failure. For GF, alloimmunity (38.7%), glomerular diseases (18.6%), and tubular injury (13.9%) were the major causes. Competing risk incidence models identified diabetes and older recipients with higher rates of both DWFG and nonalloimmune GF. Conclusions. These data suggest that at baseline, 2 distinct populations can be identified who are at high risk for renal allograft loss: a younger, nondiabetic patient group who develops GF due to alloimmunity and an older, more commonly diabetic population who develops DWFG and GF due to a mixture of causes—many nonalloimmune. Individualized management is needed to improve long-term renal allograft survival in the latter group.
UR - http://www.scopus.com/inward/record.url?scp=85124142090&partnerID=8YFLogxK
U2 - 10.1097/TXD.0000000000001273
DO - 10.1097/TXD.0000000000001273
M3 - Article
C2 - 35047660
AN - SCOPUS:85124142090
SN - 2373-8731
VL - 8
SP - E1273
JO - Transplantation Direct
JF - Transplantation Direct
IS - 2
ER -