Predicting 5-Year Risk of Kidney Transplant Failure: A Prediction Instrument Using Data Available at 1 Year Posttransplantation

Shabir, Shazia; Halimi, Jean‐Michel; Cherukuri, Aravind; Ball, Simon; Ferro, Charles J.; Lipkin, Graham; Benavente, David; Gatault, Philippe; Baker, Richard J.; Kiberd, Bryce A.; Borrows, Richard

doi:10.1053/j.ajkd.2013.10.059

Cited by 55 publications

(83 citation statements)

References 23 publications

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“…Although, not now a common cause of direct and immediate graft failure, cellular rejection remains a potent and relevant risk factor for subsequent graft failure (15)(16)(17), thereby highlighting the relevance of the current findings to contemporary transplantation. Unsurprisingly, no association between transitional B cells and ABMR was seen, as these rejection episodes were driven by nonadherence rather than a predisposing immune profile.…”

Section: Discussionmentioning

confidence: 69%

Transitional B Lymphocytes Are Associated With Protection From Kidney Allograft Rejection: A Prospective Study

Shabir

Girdlestone

Briggs

et al. 2015

American Journal of Transplantation

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Recent cross‐sectional studies suggest an important role for transitional B lymphocytes (CD19 + CD24hiCD38hi) in promoting transplant tolerance, and protecting from late antibody‐mediated rejection (ABMR). However, prospective studies are lacking. This study enrolled 73 de novo transplant recipients, and collected serial clinical, immunological and biochemical information over 48 ± 6 months. Cell phenotyping was conducted immediately prior to transplantation, and then on five occasions during the first year posttransplantation. When modeled as a time‐dependent covariate, transitional B cell frequencies (but not total B cells or “regulatory” T cells) were associated with protection from acute rejection (any Banff grade; HR: 0.60; 95% CI: 0.37–0.95; p = 0.03). No association between transitional B cell proportions and either de novo donor‐specific or nondonor‐specific antibody (dnDSA; dnNDSA) formation was evident, although preserved transitional B cell proportions were associated with reduced rejection rates in those patients developing dnDSA. Three episodes of ABMR occurred, all in the context of nonadherence, and all associated with in vitro anti‐HLA T cell responses in an ELISPOT assay (p = 0.008 versus antibody‐positive patients not experiencing ABMR). This prospective study supports the potential relevance of transitional (“regulatory”) B cells as a biomarker and therapeutic intervention in transplantation, and highlights relationships between humoral immunity, cellular immunity and nonadherence.

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Section: Discussionmentioning

confidence: 69%

Transitional B Lymphocytes Are Associated With Protection From Kidney Allograft Rejection: A Prospective Study

Shabir

Girdlestone

Briggs

et al. 2015

American Journal of Transplantation

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“…10,12,15,30,49,[54][55][56][57][58][59][60][61][62][63][64][65][66] These studies have been reviewed and are presented in Table 3. Studies by Fontan et al, 54 Amer et al, 10 and Kang et al 59 demonstrated that even a modest increase in protein excretion was associated with graft loss after adjusting for renal function.…”

Section: Prognostic Significance Of Proteinuriamentioning

confidence: 99%

Evaluation and Management of Proteinuria After Kidney Transplantation

Tsampalieros

Knoll

2015

Transplantation

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Proteinuria occurs commonly after kidney transplantation. Because there are no specific guidelines for defining and detecting proteinuria in transplant recipients, its prevalence can vary depending on the methods used. Most often, the same cutoffs for defining proteinuria in the nontransplant population are applied. There are several risk factors for proteinuria, including some transplant-specific diagnoses and immunosuppressive medications. Posttransplantation proteinuria is associated with reduced graft survival as well as an increased risk of cardiovascular events and death. Treatments to decrease proteinuria have been based on blocking the renin-angiotensin-aldosterone system with the use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. This review describes the measurement, prevalence, etiology, prognostic significance, and management of proteinuria in both adult and pediatric transplant recipients.

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“…Although risk calculators have been created for various diagnoses, procedures, and outcomes, and are used in a range of settings [2,3,5,6,16,18,22,26,35,[42][43][44][45], risk calculators for total joint arthroplasties have not been developed and fully integrated in large healthcare settings. One risk calculator for periprosthetic joint infection and mortality after THA has been developed however, it was developed only for the Medicare population [5].…”

Section: Introductionmentioning

confidence: 99%

Risk Calculators Predict Failures of Knee and Hip Arthroplasties: Findings from a Large Health Maintenance Organization

Paxton

Inacio

Khatod³

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background Considering the cost and risk associated with revision Total knee arthroplasty (TKAs) and Total hip arthroplasty (THAs), steps to prevent these operations will help patients and reduce healthcare costs. Revision risk calculators for patients may reduce revision surgery by supporting clinical decision-making at the point of care. Questions/purposes We sought to develop a TKA and THA revision risk calculator using data from a large health-maintenance organization's arthroplasty registry and determine the best set of predictors for the revision risk calculator. Methods Revision risk calculators for THAs and TKAs were developed using a patient cohort from a total joint replacement registry and data from a large US integrated healthcare system. The cohort included all patients who had primary procedures performed in our healthcare system between April 2001 and July 2008 and were followed until January 2014 (TKAs, n = 41,750; THAs, n = 22,721), During the study period, 9% of patients (TKA = 3066/ 34,686; THA=1898/20,285) were lost to followup and 7% died (TKA= 2350/41,750; THA=1419/20,285). The outcome of interest was revision surgery and was defined as replacement of any component for any reason within 5 years postoperatively. Candidate predictors for the revision risk calculator were limited to preoperative patient demographics, comorbidities, and procedure diagnoses. Logistic regression models were used to identify predictors and the Hosmer-Lemeshow goodness-of-fit test and c-statistic were used to choose final models for the revision risk calculator.

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Predicting 5-Year Risk of Kidney Transplant Failure: A Prediction Instrument Using Data Available at 1 Year Posttransplantation

Cited by 55 publications

References 23 publications

Transitional B Lymphocytes Are Associated With Protection From Kidney Allograft Rejection: A Prospective Study

Transitional B Lymphocytes Are Associated With Protection From Kidney Allograft Rejection: A Prospective Study

Evaluation and Management of Proteinuria After Kidney Transplantation

Risk Calculators Predict Failures of Knee and Hip Arthroplasties: Findings from a Large Health Maintenance Organization

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