Saha-Chaudhuri Paramita, Rabin Carly, Tchervenkov Jean, Baran Dana, Morein Justin, Sapir-Pichhadze Ruth
Department of Epidemiology, Biostatistics & Occupational Health, McGill University, Montréal, QC, Canada.
Department of Pediatrics, State University of New York Downstate Medical Center, Brooklyn, NY, USA.
Can J Kidney Health Dis. 2020 Jun 24;7:2054358120924305. doi: 10.1177/2054358120924305. eCollection 2020.
The gaps in organ supply and demand necessitate the use of expanded criteria donor (ECD) kidneys.
To identify which pre-transplant and post-transplant predictors are most informative regarding short- and long-term ECD transplant outcomes.
Retrospective cohort study.
Single center, Quebec, Canada.
The patients were 163 consecutive first-time ECD kidney only transplant recipients who underwent transplantation at McGill University Health Centre (MUHC) between January 1, 2008 and December 31, 2014 and had frozen section wedge procurement biopsies.
Short-term graft outcomes, including delayed graft function and 1-year estimated glomerular filtration rate (eGFR), as well as long-term outcomes including all-cause graft loss (defined as return to dialysis, retransplantation, and death with function).
Pre-transplant donor, recipient, and transplant characteristics were assessed as predictors of transplant outcomes. The added value of post-transplant predictors, including longitudinal eGFR, was also assessed using time-varying Cox proportional hazards models.
In univariate analyses, among the pre-transplant donor characteristics, histopathologic variables did not show evidence of association with delayed graft function, 1-year post-transplant eGFR or all cause graft loss. Recipient age was associated with all-cause graft loss (hazard ratio: 1.038 [95% confidence interval: 1.002-1.075] and the model produced only modest discrimination (C-index: 0.590; standard error [SE]: 0.045). Inclusion of time-dependent post-transplant eGFR improved the model's prediction accuracy (C-index: 0.711; SE = 0.047). Pre-transplant ECD characteristics were not associated with long-term survival, whereas post-transplant characteristics allowed better model discrimination.
Single-center study, small sample size, and potential incomplete capture of all covariate data.
Incorporation of dynamic prediction models into electronic health records may enable timely mitigation of ECD graft failure risk and/or facilitate planning for renal replacement therapies. Histopathologic findings on preimplantation biopsies have a limited role in predicting long-term ECD outcomes.
Not applicable.
器官供需缺口使得扩大标准供体（ECD）肾脏的使用成为必要。
确定哪些移植前和移植后的预测因素对ECD移植的短期和长期结果最具参考价值。
回顾性队列研究。
加拿大魁北克省的单中心。
163例连续的首次仅接受ECD肾脏移植的受者，他们于2008年1月1日至2014年12月31日在麦吉尔大学健康中心（MUHC）接受移植，并进行了冰冻切片楔形取材活检。
短期移植结果，包括移植肾功能延迟恢复和1年估计肾小球滤过率（eGFR），以及长期结果，包括全因移植肾丢失（定义为恢复透析、再次移植和有功能时死亡）。
评估移植前供体、受体和移植特征作为移植结果的预测因素。还使用时变Cox比例风险模型评估移植后预测因素（包括纵向eGFR）的附加价值。
在单因素分析中，在移植前供体特征中，组织病理学变量未显示出与移植肾功能延迟恢复、移植后1年eGFR或全因移植肾丢失相关的证据。受体年龄与全因移植肾丢失相关（风险比：1.038 [95%置信区间：1.002 - 1.075]），且该模型的辨别力仅为中等（C指数：0.590；标准误[SE]：0.045）。纳入随时间变化的移植后eGFR可提高模型的预测准确性（C指数：0.711；SE = 0.047）。移植前ECD特征与长期生存无关，而移植后特征能使模型有更好的辨别力。
单中心研究、样本量小以及可能未完全获取所有协变量数据。
将动态预测模型纳入电子健康记录可能有助于及时降低ECD移植肾失败风险和/或促进肾脏替代治疗的规划。植入前活检的组织病理学结果在预测ECD长期结果方面作用有限。
不适用。
