Risk Factors Associated With Graft Loss and Patient Survival After Kidney Transplantation

ABSTRACT Introduction: The risk of death after kidney transplant is associated with the age of the recipient, presence of comorbidities, socioeconomic status, local environmental characteristics and access to health care. Objective: To investigate the causes and risk factors associated with death during the first 5 years after kidney transplantation. Methods: This was a single-center, retrospective, matched case-control study. Results: Using a consecutive cohort of 1,873 kidney transplant recipients from January 1st 2007 to December 31st 2009, there were 162 deaths (case group), corresponding to 5-year patient survival of 91.4%. Of these deaths, 25% occurred during the first 3 months after transplant. The most prevalent cause of death was infectious (53%) followed by cardiovascular (24%). Risk factors associated with death were history of diabetes, dialysis type and time, unemployment, delayed graft function, number of visits to center, number of hospitalizations, and duration of hospital stay. After multivariate analysis, only time on dialysis, number of visits to center, and days in hospital were still associated with death. Patients who died had a non-significant higher number of treated acute rejection episodes (38% vs. 29%, p = 0.078), higher mean number of adverse events per patient (5.1 ± 3.8 vs. 3.8 ± 2.9, p = 0.194), and lower mean eGFR at 3 months (50.8 ± 25.1 vs. 56.7 ± 20.7, p = 0.137) and 48 months (45.9 ± 23.8 vs. 58.5 ± 20.2, p = 0.368). Conclusion: This analysis confirmed that in this population, infection is the leading cause of mortality over the first 5 years after kidney transplantation. Several demographic and socioeconomic risk factors were associated with death, most of which are not readily modifiable.

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Ureteral Necrosis after Kidney Transplantation: Risk Factors and Impact on Graft and Patient Survival

Transplantation Journal ◽

10.1097/01.tp.0000131953.13414.99 ◽

2004 ◽

Vol 78 (5) ◽

pp. 725-729 ◽

Cited By ~ 70

Author(s):

Georges Karam ◽

Fr??d??ric Maillet ◽

Sophie Parant ◽

Jean-Paul Soulillou ◽

Magali Giral-Classe

Keyword(s):

Risk Factors ◽

Kidney Transplantation ◽

Patient Survival ◽

Ureteral Necrosis

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Early Graft Loss After Kidney Transplantation: Risk Factors and Consequences.

Transplantation Journal ◽

10.1097/00007890-201407151-02130 ◽

2014 ◽

Vol 98 ◽

pp. 629-630 ◽

Cited By ~ 1

Author(s):

M. Hamed ◽

L. Pasea ◽

J. Bradley ◽

G. Pettigrew ◽

K. Saeb-Parsy

Keyword(s):

Risk Factors ◽

Kidney Transplantation ◽

Graft Loss ◽

Early Graft

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Outcomes of Carbapenem-Resistant Klebsiella pneumoniae Infection and the Impact of Antimicrobial and Adjunctive Therapies

Infection Control and Hospital Epidemiology ◽

10.1086/592412 ◽

2008 ◽

Vol 29 (12) ◽

pp. 1099-1106 ◽

Cited By ~ 528

Author(s):

Gopi Patel ◽

Shirish Huprikar ◽

Stephanie H. Factor ◽

Stephen G. Jenkins ◽

David P. Calfee

Keyword(s):

Risk Factors ◽

Klebsiella Pneumoniae ◽

Case Control Study ◽

Patient Survival ◽

Case Control ◽

Factors Associated ◽

Carbapenem Resistant ◽

Matched Case ◽

The Impact ◽

Control Study

Background.Carbapenem-resistant Klebsiella pneumoniae is an emerging healthcare-associated pathogen.Objective.To describe the epidemiology of and clinical outcomes associated with carbapenem-resistant K. pneumoniae infection and to identify risk factors associated with mortality among patients with this type of infection.Setting.Mount Sinai Hospital, a 1,171-bed tertiary care teaching hospital in New York City.Design.Two matched case-control studies.Methods.In the first matched case-control study, case patients with carbapenem-resistant K. pneumoniae infection were compared with control patients with carbapenem-susceptible K. pneumoniae infection. In the second case-control study, patients who survived carbapenem-resistant K. pneumoniae infection were compared with those who did not survive, to identify risk factors associated with mortality among patients with carbapenem-resistant K. pneumoniae infection.Results.There were 99 case patients and 99 control patients identified. Carbapenem-resistant K. pneumoniae infection was independently associated with recent organ or stem-cell transplantation (P = .008), receipt of mechanical ventilation (P = .04), longer length of stay before infection (P = .01), and exposure to cephalosporins (P = .02) and carbapenems (P < .001). Case patients were more likely than control patients to die during hospitalization (48% vs 20%; P < .001) and to die from infection (38% vs 12%; P < .001). Removal of the focus of infection (ie, debridement) was independently associated with patient survival (P = .002). The timely administration of antibiotics with in vitro activity against carbapenem-resistant K. pneumoniae was not associated with patient survival.Conclusions.Carbapenem-resistant K. pneumoniae infection is associated with numerous healthcare-related risk factors and with high mortality. The mortality rate associated with carbapenem-resistant K. pneumoniae infection and the limited antimicrobial options for treatment of carbapenem-resistant K. pneumoniae infection highlight the need for improved detection of carbapenem-resistant K. pneumoniae infection, identification of effective preventive measures, and development of novel agents with reliable clinical efficacy against carbapenem-resistant K. pneumoniae.

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P1706THE GRAFT SURVIVAL OF KIDNEY TRANSPLANTATION ACCORDING TO ETHNICITY IN KIDNEY TRANSPLANT RECIPIENTS

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p1706 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Yeonsoon Jung ◽

Jisu Kim ◽

Haesu Jeon ◽

Ye Na Kim ◽

Ho Sik Shin ◽

...

Keyword(s):

African American ◽

Kidney Transplantation ◽

Kidney Transplant ◽

Graft Survival ◽

Cox Regression ◽

Patient Survival ◽

Graft Loss ◽

Transplant Recipients ◽

Kidney Transplant Recipients ◽

Data Set

Abstract Background African American kidney transplant recipients experience disproportionately high rates of graft loss. The aim of this analysis was to use a UNOS data set that contains detailed baseline and longitudinal clinical data to establish and quantify the impact of the current overall graft loss definition on suppressing the true disparity magnitude in US AA kidney transplant outcomes. Methods Longitudinal cohort study of kidney transplant recipients using a data set created by United Network for Organ Sharing (UNOS), including 266,128 (African American 70,215, Non-African American 195,913) transplant patient between 1987 and December 2016. Multivariable analysis was conducted using 2-stage joint modeling of random and fixed effects of longitudinal data (linear mixed model) with time to event outcomes (Cox regression). Results 195,913 non-African American (AA) (73.6%) were compared with 70,215 AA (26.4%) recipients. 10-year-graft survival of AA in all era is lower than that of non-AA (31% in deceased kidney transplants (DKT) AA recipient and 42% in living kidney transplantation (LKT) non-AA recipient). 10-year-patient survival of AA with functioning graft in all era is similar that of non-AA. Multivariate Cox regression of factors associated with patient survival with functioning graft are acute rejection within 6 months, DM, hypertension and etc. Pre-transplant recipient BMI in AA show the trend as a protective factor in patient survival with functioning graft although not significantly in statistics Conclusions African American kidney transplant recipients experience a substantial disparity in graft loss, but not patient death with functioning graft.

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The risk factors associated with treatment-related mortality in 16,073 kidney transplantation—A nationwide cohort study

PLoS ONE ◽

10.1371/journal.pone.0236274 ◽

2020 ◽

Vol 15 (7) ◽

pp. e0236274 ◽

Cited By ~ 2

Author(s):

Hyunji Choi ◽

Woonhyoung Lee ◽

Ho Sup Lee ◽

Seom Gim Kong ◽

Da Jung Kim ◽

...

Keyword(s):

Risk Factors ◽

Cohort Study ◽

Kidney Transplantation ◽

Factors Associated ◽

Treatment Related Mortality ◽

Related Mortality

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Clinical Relevance of HLA Antibody Monitoring after Kidney Transplantation

Journal of Immunology Research ◽

10.1155/2014/845040 ◽

2014 ◽

Vol 2014 ◽

pp. 1-5 ◽

Cited By ~ 27

Author(s):

Christian Morath ◽

Gerhard Opelz ◽

Martin Zeier ◽

Caner Süsal

Keyword(s):

Risk Factors ◽

Kidney Transplantation ◽

Organ Transplantation ◽

Clinical Relevance ◽

De Novo ◽

Graft Loss ◽

Specific Antibodies ◽

Graft Outcome ◽

The Impact ◽

Hla Antibody

In kidney transplantation, antibody-mediated allograft injury caused by donor HLA-specific antibodies (DSA) has recently been identified as one of the major causes of late graft loss. This paper gives a brief overview on the impact of DSA development on graft outcome in organ transplantation with a focus on risk factors forde novoalloantibody induction and recently published guidelines for monitoring of DSA during the posttransplant phase.

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Early Graft Loss After Kidney Transplantation: Risk Factors and Consequences

American Journal of Transplantation ◽

10.1111/ajt.13162 ◽

2015 ◽

Vol 15 (6) ◽

pp. 1632-1643 ◽

Cited By ~ 46

Author(s):

M. O. Hamed ◽

Y. Chen ◽

L. Pasea ◽

C. J. Watson ◽

N. Torpey ◽

...

Keyword(s):

Risk Factors ◽

Kidney Transplantation ◽

Graft Loss ◽

Early Graft

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Immunosuppression as a Risk Factor for De Novo Angiotensin II Type Receptor Antibodies Development after Kidney Transplantation

Journal of Clinical Medicine ◽

10.3390/jcm10225390 ◽

2021 ◽

Vol 10 (22) ◽

pp. 5390

Author(s):

Bogdan Marian Sorohan ◽

Ioanel Sinescu ◽

Dorina Tacu ◽

Cristina Bucșa ◽

Corina Țincu ◽

...

Keyword(s):

Risk Factors ◽

Kidney Transplantation ◽

Angiotensin Ii ◽

De Novo ◽

Multivariate Logistic Regression Analysis ◽

Study Cohort ◽

Type I ◽

Factors Associated ◽

Maintenance Immunosuppression ◽

Receptor Antibodies

(1) Background: Angiotensin II type I receptor antibodies (AT1R-Ab) represent a topic of interest in kidney transplantation (KT). Data regarding the risk factors associated with de novo AT1R-Ab development are lacking. Our goal was to identify the incidence of de novo AT1R-Ab at 1 year after KT and to evaluate the risk factors associated with their formation. (2) Methods: We conducted a prospective cohort study on 56 adult patients, transplanted between 2018 and 2019. Recipient, donor, transplant, treatment, and complications data were assessed. A threshold of >10 U/mL was used for AT1R-Ab detection. (3) Results: De novo AT1R-Ab were observed in 12 out of 56 KT recipients (21.4%). The median value AT1R-Ab in the study cohort was 8.5 U/mL (inter quartile range: 6.8–10.4) and 15.6 U/mL (10.8–19.8) in the positive group. By multivariate logistic regression analysis, induction immunosuppression with anti-thymocyte globulin (OR = 7.20, 95% CI: 1.30–39.65, p = 0.02), maintenance immunosuppression with immediate-release tacrolimus (OR = 6.20, 95% CI: 1.16–41.51, p = 0.03), and mean tacrolimus trough level (OR = 2.36, 95% CI: 1.14–4.85, p = 0.01) were independent risk factors for de novo AT1R-Ab at 1 year after KT. (4) Conclusions: De novo AT1R-Ab development at 1 year after KT is significantly influenced by the type of induction and maintenance immunosuppression.

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MO963GRAFT- AND PATIENT-SURVIVAL AFTER FIRST KIDNEY TRANSPLANT BIOPSY

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab110.0042 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Salmir Nasic ◽

Johan Mölne ◽

Bernd Stegmayr ◽

Marie Felldin ◽

Björn Peters

Keyword(s):

Kidney Transplantation ◽

Graft Survival ◽

Patient Survival ◽

Graft Loss ◽

Glomerular Diseases ◽

Hematological Diseases ◽

Antibody Mediated Rejection ◽

Transplant Kidney ◽

Grade Ii ◽

Transplant Biopsy

Abstract Background and Aims Kidney transplantation is frequently used as a treatment in uremic patients. However, long term function is not easily predicted. The aim of this study was to investigate to what extent histological diagnosis in the first registered transplant kidney biopsy is related to clinical outcome. Method Included were data of 1463 patients (36.6 % women, 63.4 % men) that were merged from a kidney transplantation register and a biopsy register. These patients obtained their first registered transplant biopsy during the period January 1, 2007 until July 30, 2017. Fisher’s exact test and χ-2 analyses were used for cross-tabulation of data. Graft- and patient-survival analysis was performed by Kaplan-Meier analysis with log-rank tests comparing different groups and in next step age and gender adjusted analysis were performed by multivariate Cox-regression-analysis. Data are presented as Hazard Ratio (HR) and 95% Confidence Intervals (CI). A two-sided p-value of <0.05 was considered as statistically significant. Results The graft-survival was shorter for patients with biopsy-proven glomerular diseases (HR 8.1, CI 3.1-20.7) and rejections (HR 4.3, CI 1.7 -10.5) compared to normal biopsy findings. Further, there was a shorter graft-survival for those with chronic damages (HR 3.2, CI 1.3-8.0), acute tubular injuries (HR 3.0, CI 1.2-7.8), and borderline changes (HR 2.9, CI 1.1-7.6). The patient-survival was reduced for patients with biopsy-proven hematological diseases (HR 9.6, CI 2.1-44.0). Sub analysis of all types of rejections showed shorter graft-survival for chronic T-cell-mediated rejection (TCMR) (HR 4.8, CI 2.1-11.7), active antibody-mediated rejection (ABMR) (HR 4.4, CI 2.1-9.3), chronic ABMR (HR 3.8, CI 2.2-6.7), combined chronic ABMR and TCMR (HR 4.0, CI 2.4-6.9) and other rejections (HR 3.3, CI 1.1-9.6) compared to acute TCMR. Patients with TCMR Banff grade II rejection had a better graft-survival (HR 0.35, CI 0.20-0.63) compared to other rejections as well as patients with TCMR Banff grade I (HR 0.52, CI 0.29-0.93). 265 patients had graft-loss and 42 of those patients died afterwards (15.8%). Of the 42 who died after graft-loss 9 patients died within 30 days after transplant failure (21.4%). Conclusion A shorter graft-survival was found in kidneys with glomerular diseases, rejections, acute tubular injuries, borderline changes and chronic damages. A shorter patient-survival was noted for patients with transplant kidney biopsies with hematological diseases. Patients with Banff grade II rejection had a better graft-survival compared to all other diagnosis and other rejections. Further, awareness should be given to patients the first month after graft-loss.

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