Department of Transplant Nephrology, Colombiana de Trasplantes, Bogotá, Colombia.
Department of Transplant Research, Colombiana de Trasplantes, Bogotá, Colombia.
PLoS One. 2022 Jul 14;17(7):e0269990. doi: 10.1371/journal.pone.0269990. eCollection 2022.
Kidney transplantation is the best therapeutical option for CKD patients. Graft loss risk factors are usually estimated with the cox method. Competing risk analysis could be useful to determine the impact of different events affecting graft survival, the occurrence of an outcome of interest can be precluded by another. We aimed to determine the risk factors for graft loss in the presence of mortality as a competing event.
A retrospective cohort of 1454 kidney transplant recipients who were transplanted between July 1, 2008, to May 31, 2019, in Colombiana de Trasplantes, were analyzed to determine risk factors of graft loss and mortality at 5 years post-transplantation. Kidney and patient survival probabilities were estimated by the competing risk analysis. The Fine and Gray method was used to fit a multivariable model for each outcome. Three variable selection methods were compared, and the bootstrapping technique was used for internal validation as split method for resample. The performance of the final model was assessed calculating the prediction error, brier score, c-index and calibration plot.
Graft loss occurred in 169 patients (11.6%) and death in 137 (9.4%). Cumulative incidence for graft loss and death was 15.8% and 13.8% respectively. In a multivariable analysis, we found that BKV nephropathy, serum creatinine and increased number of renal biopsies were significant risk factors for graft loss. On the other hand, recipient age, acute cellular rejection, CMV disease were risk factors for death, and recipients with living donor had better survival compared to deceased-donor transplant and coronary stent. The c-index were 0.6 and 0.72 for graft loss and death model respectively.
We developed two prediction models for graft loss and death 5 years post-transplantation by a unique transplant program in Colombia. Using a competing risk multivariable analysis, we were able to identify 3 significant risk factors for graft loss and 5 significant risk factors for death. This contributes to have a better understanding of risk factors for graft loss in a Latin-American population. The predictive performance of the models was mild.
肾移植是治疗慢性肾脏病（CKD）患者的最佳治疗选择。移植物丢失的风险因素通常使用 Cox 方法进行评估。竞争风险分析可能有助于确定影响移植物存活的不同事件的影响，发生感兴趣的结果可以排除另一个事件的发生。我们旨在确定在存在死亡作为竞争事件的情况下移植物丢失的风险因素。
对 2008 年 7 月 1 日至 2019 年 5 月 31 日在哥伦比亚移植中心接受肾移植的 1454 例患者进行回顾性队列分析，以确定 5 年后移植物丢失和死亡率的风险因素。通过竞争风险分析估计肾和患者的生存概率。使用 Fine 和 Gray 方法为每个结果拟合多变量模型。比较了三种变量选择方法，并使用分拆法进行内部验证。使用bootstrap 技术进行重新采样。通过计算预测误差、Brier 评分、c 指数和校准图来评估最终模型的性能。
169 例患者（11.6%）发生移植物丢失，137 例患者（9.4%）死亡。移植物丢失和死亡的累积发生率分别为 15.8%和 13.8%。多变量分析发现，BK 病毒肾病、血清肌酐和增加的肾活检数量是移植物丢失的显著危险因素。另一方面，受者年龄、急性细胞排斥、巨细胞病毒疾病是死亡的危险因素，活体供者的受者与尸肾移植和冠状动脉支架相比具有更好的生存。移植物丢失和死亡模型的 c 指数分别为 0.6 和 0.72。
我们通过哥伦比亚的一个独特的移植项目开发了两个预测模型，用于移植后 5 年的移植物丢失和死亡。使用竞争风险多变量分析，我们能够确定 3 个移植物丢失的显著危险因素和 5 个死亡的显著危险因素。这有助于更好地了解拉丁美洲人群中移植物丢失的危险因素。模型的预测性能一般。
