Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio.
Center for Populations Health Research, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio.
Kidney360. 2022 Jan 25;3(4):714-727. doi: 10.34067/KID.0007342021. eCollection 2022 Apr 28.
Estimated glomerular filtration rate (eGFR) at 1 year post transplantation has been shown to be a strong predictor of long-term graft survival. However, intercurrent events (ICEs) may affect the relationship between eGFR and failure risk.
The OPTN and USRDS databases on single-organ kidney transplant recipients from 2012 to 2016 were linked. Competing risk regressions estimated adjusted subhazard ratios (SHRs) of 12-month eGFR on long-term graft failure, considering all-cause mortality as the competing risk, for deceased donor (DD) and living donor (LD) recipients. Additional predictors included recipient, donor, and transplant characteristics. ICEs examined were acute rejection, cardiovascular events, and infections.
Cohorts comprised 25,131 DD recipients and 7471 LD recipients. SHRs for graft failure increased rapidly as 12-month eGFR values decreased from the reference 60 ml/min per 1.73 m. At an eGFR of 20 ml/min per 1.73 m, SHRs were 13-15 for DD recipients and 12-13 for LD recipients; at an eGFR of 30 ml/min per 1.73 m, SHRs were 5.0-5.7 and 5.0-5.5, respectively. Among first-year ICEs, acute rejection was a significant predictor of long-term graft failure in both DD (SHR=1.63, <0.001) and LD (SHR=1.51, =0.006) recipients; cardiovascular events were significant in DD (SHR=1.24, <0.001), whereas non-CMV infections were significant in the LD cohort (SHR=1.32, =0.03). Adjustment for ICEs did not significantly reduce the association of eGFR with graft failure.
Twelve-month eGFR is a strong predictor of long-term graft failure after accounting for clinical events occurring from discharge to 1 year. These findings may improve patient management and clinical evaluation of novel interventions.
移植后 1 年的估计肾小球滤过率（eGFR）已被证明是长期移植物存活的强有力预测因子。然而，并发事件（ICEs）可能会影响 eGFR 与失败风险之间的关系。
将 2012 年至 2016 年的 OPTN 和 USRDS 数据库中的单器官肾移植受者进行了链接。使用竞争风险回归分析，考虑全因死亡率作为竞争风险，对供体死亡（DD）和活体供体（LD）受者的 12 个月 eGFR 与长期移植物失败的调整后亚风险比（SHR）进行了估计。其他预测因素包括受者、供者和移植特征。检查的 ICEs 包括急性排斥反应、心血管事件和感染。
队列包括 25131 名 DD 受者和 7471 名 LD 受者。随着 12 个月 eGFR 值从参考值 60 ml/min/1.73 m 逐渐降低，移植物失败的 SHR 迅速增加。在 eGFR 为 20 ml/min/1.73 m 时，DD 受者的 SHR 为 13-15，LD 受者为 12-13；在 eGFR 为 30 ml/min/1.73 m 时，SHR 分别为 5.0-5.7 和 5.0-5.5。在第一年的 ICEs 中，急性排斥反应是 DD（SHR=1.63，<0.001）和 LD（SHR=1.51，=0.006）受者长期移植物失败的重要预测因子；心血管事件在 DD 中显著（SHR=1.24，<0.001），而非 CMV 感染在 LD 队列中显著（SHR=1.32，=0.03）。调整 ICEs 并不能显著降低 eGFR 与移植物失败的相关性。
在考虑出院至 1 年期间发生的临床事件后，12 个月 eGFR 是长期移植物失败的有力预测因子。这些发现可能会改善患者管理和对新型干预措施的临床评估。
