Risk Factors of Graft Survival After Diagnosis of Post-kidney Transplant Malignancy: Using Cox Proportional Hazard Model

Abstract

Background:All recipients of kidney transplantation, especially those with posttransplant malignancy, are at risk of long-term graft failure.Objectives:The purpose of our study was to evaluate the risk factors associated with graft survival after diagnosis of malignancy.Patients and Methods:To reach this purpose, we conducted a historical cohort study in Iran and 266 cases with posttransplant malignancy were followed up from diagnosis of malignancy until long-term graft loss or the date of last visit. These patients were taken as a census from 16 Transplant Centers in Iran during 22 years follow-up period since October 1984 to December 2008. A Cox proportional hazards model was performed to determine the important independent predictors of graft survival after malignancy.Results:At the end of the study, long-term graft failure was seen in 27 (10.2%) cases. One-year and 2-year graft survival after diagnosis of cancer were 93.6% and 91.7%, respectively. The univariate analysis showed that the incidence of chronic graft loss was significantly higher in male patients with solid cancers, withdrawal of immunosuppressant regimen, no response to treatment, and tumor metastasis. In continuation, the Cox model indicated that the significant risk factors associated with graft survival were type of cancer (P < 0.0001), response to treatment (P < 0.0001, HR = 0.14, 95% CI: 0.06 - 0.32), metastasis (P < 0.0001, HR = 5.68, 95% CI: 2.24 - 14.42), and treatment modality (P = 0.0001).Conclusions:By controlling the modifiable risk factors and modality of treatment in our study, physicians can reach more effective treatment.

Incidence, Risk Factors, and Outcomes of De Novo Malignancy following Kidney Transplantation

“…The observed multicollinear relationship between age, DPTM occurrence, and graft survival has not previously been highlighted. Previous studies have identified specific cancer types, treatment modalities, and response to treatment as significant predictors of graft survival following DPTM diagnosis [49,50] However, the optimal management strategies for balancing cancer control and graft preservation remain areas of ongoing investigation, thus necessitating personalized approaches tailored to individual patient characteristics and treatment responses.…”

Assessing Risk Indicators of Allograft Survival of Renal Transplant: An Application of Joint Modeling of Longitudinal and Time-to-Event Analysis

“…In recent decades, a large volume of medical and statistical research has been performed to identify the effective factors for the survival rate of renal graft throughout the world (15,16,18,22,25,26,28,33). In these studies, the data analysts generally applied the usual statistical models, such as Cox proportional hazards or other well-known parametric or semi-parametric survival models.…”

“…Foroushani et al, in 2015, assessed long-term kidney graft failure and evaluated the risk factors of graft survival of patients who had malignancy after transplantation (15). Ghanei et al, in a historical cohort study, evaluated shortand long-term graft survival of patients who underwent kidney transplants from living or deceased donors.…”