Long-term outcomes after kidney transplant failure and variables related to risk of death and probability of retransplant: Results from a single-center cohort study in Brazil

Abstract

Background Returning to dialysis after kidney graft loss (GL) is associated with a high risk of mortality, mainly in the first 3–6 months. The follow-up of patients with GL should be extended to better understand crude patient outcomes, mainly in emerging countries, where the transplantation activity has increased. Methods This is a historical single-center cohort study conducted in an emerging country (Brazil) that included 115 transplant patients with kidney allograft failure who were followed for 44.1 (21.4; 72.6) months after GL. The outcomes were death or retransplantation after GL calculated by Kaplan-Meier and log-rank tests. Proportional hazard ratios for death and retransplantation were assessed by Cox regression. Results The 5-year probability of retransplantation was 38.7% (95% CI: 26.1%-51.2%) and that of death was 37.7% (95% CI: 24.9%-50.5%); OR = 1.03 (95% CI: 0.71–1.70) and P = 0.66. The likelihood of retransplantation was higher in patients who resumed dialysis with higher levels of hemoglobin (HR = 1.22; 95% CI = 1.04–1.43; P = 0.01) and lower in blood type O patients (HR = 0.48; 95% CI = 0.25–0.93; P = 0.03), which was associated with a lower frequency of retransplantation with a subsequent living-donor kidney. On the other hand, the risk of death was significantly associated with Charlson comorbidity index (HR for each point = 1.37; 95% CI 1.19–1.50; P<0.001), and residual eGFR at the time when patients had resumed to dialysis (HR for each mL = 1.14; 95% CI = 1.05–1.25; P = 0.002). The trend toward a lower risk of death when patients had resumed to dialysis using AV fistula access was observed (HR = 0.50; 95% CI 0.25–1.02; P = 0.06), while a higher risk seems to be associated with the number of previous engraftment (HR = 2.01; 95% CI 0.99–4.07; P = 0.05). Conclusions The 5-year probability of retransplantation was not less than that of death. Variables related to the probability of retransplantation were hemoglobin level before resuming dialysis and ABO blood type, while the risk of death was associated with comorbidities and residual eGFR.

Classification of imbalanced data using machine learning algorithms to predict the risk of renal graft failures in Ethiopia

“…The development of new immunosuppressive drugs and clinical care advancements considerably improved the short-term outcomes after kidney transplantation [4]. Despite this, long-term graft survival and loss due to chronic kidney dysfunction and death with a functional graft remain the leading causes of long-term graft loss [5,6]. Therefore, predicting the risk of long-term graft failure across the transplant cohort is essential.…”

Continuation of immunosuppression vs. immunosuppression weaning in potential repeat kidney transplant candidates: a care management perspective

“…It is estimated that approximately 4% of prevalent dialysis patients in the United States are prior kidney transplant recipients (12). Studies demonstrate that for transplant recipients who return to dialysis, there are increased risks of cardiovascular complications, infection, and death compared with incident dialysis patients without a transplant (13)(14)(15). One plausible explanation for these observations is the continued use of immunosuppressive medications, which increase the risk of infections and lead to an adverse cardiovascular profile (13).…”

“…Studies demonstrate that for transplant recipients who return to dialysis, there are increased risks of cardiovascular complications, infection, and death compared with incident dialysis patients without a transplant (13)(14)(15). One plausible explanation for these observations is the continued use of immunosuppressive medications, which increase the risk of infections and lead to an adverse cardiovascular profile (13). Prior kidney transplant recipients who return to dialysis may also represent a sicker population, returning to dialysis after medical complications.…”