de Cos Gomez Marina, Benito Hernandez Adalberto, Garcia Unzueta Maria Teresa, Mazon Ruiz Jaime, Lopez Del Moral Cuesta Covadonga, Perez Canga Jose Luis, San Segundo Arribas David, Valero San Cecilio Rosalia, Ruiz San Millan Juan Carlos, Rodrigo Calabia Emilio
Nephrology Department, Hospital Universitario Marques de Valdecilla, Avenida Valdecilla n 5, 39724 Santander, Spain.
Valdecilla Biomedical Research Institute (IDIVAL), Cardenal Herrera Oria S/N, 39011 Santander, Spain.
J Clin Med. 2020 Dec 20;9(12):4112. doi: 10.3390/jcm9124112.
Kidney transplantation implies a significant improvement in patient survival. Nevertheless, early mortality after transplant remains high. Growth differentiation factor 15 (GDF-15) is a novel biomarker under study as a mortality predictor in multiple scenarios. The aim of this study is to assess the utility of GDF-15 to predict survival in kidney transplant candidates. For this purpose, 395 kidney transplant recipients with pretransplant stored serum samples were included. The median GDF-15 was 5331.3 (50.49-16242.3) pg/mL. After a mean of 90.6 ± 41.5 months of follow-up, 82 (20.8%) patients died. Patients with higher GDF-15 levels (high risk tertile) had a doubled risk of mortality after adjustment by clinical characteristics ( = 0.009). After adjustment by EPTS (Estimated Post Transplant Survival score) the association remained significant for medium hazards ratios (HR) 3.24 95%CI (1.2-8.8), = 0.021 and high risk tertiles HR 4.3 95%CI (1.65-11.54), = 0.003. GDF-15 improved the prognostic accuracy of EPTS at 1-year (ΔAUC = 0.09, = 0.039) and 3-year mortality (ΔAUC = 0.11, = 0.036). Our study suggests an independent association between higher GDF-15 levels and mortality after kidney transplant, adding accuracy to the EPTS score, an established risk prediction model currently used in kidney transplant candidates.
肾移植意味着患者生存率有显著提高。然而，移植后的早期死亡率仍然很高。生长分化因子15（GDF-15）是一种正在研究的新型生物标志物，可作为多种情况下的死亡预测指标。本研究的目的是评估GDF-15在预测肾移植候选者生存率方面的效用。为此，纳入了395例移植前储存血清样本的肾移植受者。GDF-15的中位数为5331.3（50.49 - 16242.3）pg/mL。经过平均90.6±41.5个月的随访，82例（20.8%）患者死亡。GDF-15水平较高（高风险三分位数）的患者在经临床特征调整后死亡风险增加一倍（P = 0.009）。经EPTS（估计移植后生存评分）调整后，中等风险比（HR）为3.24，95%CI（1.2 - 8.8），P = 0.021，高风险三分位数HR为4.3，95%CI（1.65 - 11.54），P = 0.003，这种关联仍然显著。GDF-15在1年（ΔAUC = 0.09，P = 0.039）和3年死亡率（ΔAUC = 0.11，P = 0.036）时提高了EPTS的预后准确性。我们的研究表明，较高的GDF-15水平与肾移植后死亡率之间存在独立关联，为EPTS评分增加了准确性，EPTS评分是目前用于肾移植候选者的既定风险预测模型。
