Department of Nephrology, Kanazawa Medical University School of Medicine, 1-1 Daigaku, Uchinada, 920-0293, Ishikawa, Japan.
Adachi Kidney Dialysis Hypertension Clinic, 5-147 Toita, Kanazawa, 920-0068, Ishikawa, Japan.
Sci Rep. 2024 Nov 21;14(1):28858. doi: 10.1038/s41598-024-80407-0.
The estimated glomerular filtration rate (eGFR) at 1 year post-transplantation is a well-established predictor of long-term graft survival; however, its predictive accuracy needs improvement. We retrospectively analyzed data from 51 kidney transplant recipients at Kanazawa Medical University Hospital (January 2001-February 2015). Cox regression was used to identify risk factors for death-censored graft loss and create a nomogram to predict graft survival at 15 years post-transplantation. The predictive factors ultimately included in the nomogram included eGFR and serum glucose-regulated protein 78 (GRP78) at 1 year post-transplantation. In terms of discrimination, assessed by area under the receiver operating characteristic curve (AUC-ROC), no significant difference was noted between the eGFR model (AUC 0.84 [0.67-1.00]) and nomogram (AUC 0.92 [0.82-1.00]) (p = 0.38). However, calibration, evaluated by the calibration plot, indicated superiority of the nomogram over the eGFR model, confirmed in the internal validation cohort using the Bootstrap method. Regarding clinical value evaluated by decision curve analysis, the nomogram showed a greater net benefit than the eGFR model, especially at wider diagnostic thresholds (particularly important lower thresholds). Our findings suggest the added predictive value of serum GRP78 at 1 year post-transplantation for long-term graft survival prediction.
移植后 1 年的估算肾小球滤过率（eGFR）是长期移植物存活的良好预测指标；然而，其预测准确性仍需提高。我们回顾性分析了金泽医科大学医院（2001 年 1 月至 2015 年 2 月）51 例肾移植受者的数据。使用 Cox 回归分析确定死亡风险相关因素，创建列线图预测移植后 15 年的移植物存活率。最终纳入列线图的预测因素包括移植后 1 年的 eGFR 和血清葡萄糖调节蛋白 78（GRP78）。通过受试者工作特征曲线（ROC-AUC）评估，eGFR 模型（AUC 0.84 [0.67-1.00]）和列线图（AUC 0.92 [0.82-1.00]）之间的差异无统计学意义（p=0.38）。但是，通过校准图评估校准，列线图的优势优于 eGFR 模型，使用 Bootstrap 方法在内部验证队列中得到了证实。关于通过决策曲线分析评估的临床价值，列线图的净收益大于 eGFR 模型，尤其是在更宽的诊断阈值（特别是重要的低阈值）下。我们的研究结果表明，移植后 1 年血清 GRP78 对长期移植物存活预测具有附加预测价值。
