Introduction
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.
Methods
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.
Results
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.
Conclusion
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.
Introducción: El uso de donantes de criterios expandidos (DCE) es una alternativa para suplir la necesidad existente de donantes de órganos. Objetivo: Evaluar los principales desenlaces a un año de los trasplantados renales con DCE en la región Caribe colombiana. Metodología: Cohorte retrospectiva de pacientes trasplantados entre 2013 y 2018. Se compararon los grupos de DCE y donantes de criterios estándar (DCS) y su asociación a los principales desenlaces. Se analizó la supervivencia del injerto y del paciente por medio del método de Kaplan-Meier. Resultados: 78 pacientes fueron incluidos, de estos, 57 eran receptores de DCS y 21 receptores de DCE. El rechazo celular agudo se presentó en el 46.2% (n = 36), siendo el 52.4% en trasplantados con DCE (riesgo relativo [RR]: 1.19; intervalo de confianza del 95% [IC 95%]: 0.72-1.97). La frecuencia de reingreso hospitalario fue del 45.1%, la complicación más frecuente fue la infección de vías urinarias, siendo el 28.6% en DCE. Once pacientes perdieron el injerto para una supervivencia del injerto del 84.9%. La supervivencia del injerto en el grupo de DCS fue del 90.7% (IC 95%: 79.0-96.0), comparada con el 69.2% en el grupo de DCE . Conclusión: Se encontró una diferencia significativa en la supervivencia del injerto de trasplantados renales con DCE y DCS.Palabras clave: Trasplante de riñón. Donante de criterios expandidos. Donante de criterios estándar. Supervivencia del injerto.
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