Pretransplant risk stratification for early survival of renal allograft recipients.
Eur J Clin Invest
; 44(2): 168-75, 2014 Feb.
Article
en En
| MEDLINE
| ID: mdl-24224947
ABSTRACT
BACKGROUND:
Baseline comorbidities influence patient outcomes in renal transplantation. Identification of high-risk recipients for patient death and early allograft loss might lead to superior stratification. MATERIAL ANDMETHODS:
In this retrospective study, risk stratification models were developed in a cohort of 392 kidney transplant recipients and validated in an independent cohort to predict short-term (2 year) outcomes.RESULTS:
Peripheral arterial disease [OR 7·7 (95% confidence interval (CI) 2·45-24·60); P < 0·001], use of oral anticoagulation [OR 18·68 (95% CI 3·77-92·46); P < 0·0001], smoking [OR 5·15 (95% CI 1·67-15·84); P = 0·004], recipient age > 60 years [OR 7·28 (95% CI 2·33-22·69; P = 0·001)], serum albumin < 40 g/L [OR 5·08 (95% CI 1·82-14·19); P = 0·002], serum calcium ≥ 2·42 mM [OR 6·47 (95% CI 1·37-30·58); P = 0·02] living donation [OR 2·95, (95% CI 0·31-28·29); P = 0·34)] and previous haemodialysis [OR 3·33, (95% CI 0·39-28·11); P = 0·27)] were included in the model. The validated model discriminated between low- (< 3 points) and high-risk recipients (> 8·5 points) with mortality rates of 0% vs. 54%. The comparison of the model with the Charlson comorbidity index (CCI) yielded significantly better receiver operating characteristic (ROC) areas (Novel Score ROC 0·87 vs. CCI 0·72, P = 0·0012). Early allograft loss was associated with presensitization [OR 3·02 (95% CI 1·29-7·09); P = 0·011] and presence of hepatitis C antibodies [OR 2·42 (95% CI 1·09-5·34); P = 0·029]. A risk model (ROC 0·62) for allograft loss could not be developed.CONCLUSION:
Risk stratification based on the novel score might identify high-risk recipients with disproportional risk of early patient death and lead to optimized strategies.Palabras clave
Texto completo:
1
Colección:
01-internacional
Banco de datos:
MEDLINE
Asunto principal:
Trasplante de Riñón
Tipo de estudio:
Etiology_studies
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Observational_studies
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Prognostic_studies
/
Risk_factors_studies
Límite:
Adult
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
Eur J Clin Invest
Año:
2014
Tipo del documento:
Article
País de afiliación:
Austria