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Clinical Indicators of Renal Allograft Loss. Lawrence Y.C. Agodoa, MD FACP Jon J. Snyder, MS Bertram L. Kasiske, MD Allan J. Collins, MD FACP United States Renal Data System Department of Health and Human Services National Institutes of Health

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clinical indicators of renal allograft loss

Clinical Indicators of Renal Allograft Loss

Lawrence Y.C. Agodoa, MD FACP

Jon J. Snyder, MS

Bertram L. Kasiske, MD

Allan J. Collins, MD FACP

United States Renal Data System

Department of Health and Human Services

National Institutes of Health

National Institute of Diabetes and Digestive and Kidney Diseases

National Institute of Diabetes and Digestive and Kidney Diseases

renal allograft survival probabilities us adjusted for age gender race and primary disease
Renal Allograft Survival Probabilities, US; adjusted for age, gender, race and primary disease

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causes of renal allograft loss
Causes of Renal Allograft Loss

Acute – Mechanical

- Immune mediated

Early - Immune mediated

- Non-immune

Late - Non-immune

I M M U N O L O G I C

Clinical Indicators

NON- IMMUNOLOGIC

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study objectives
Study Objectives
  • Determine how various clinical indicators affect graft survival in the cadaveric and living donor transplant recipients.
  • Three outcomes were considered:
    • Graft failure (including death)
    • Death-censored graft failure (graft loss without death)
    • Death with functioning graft
  • Due to factors unique to cadaveric vs. living donor recipients, cadaveric transplant recipients are analyzed separately from recipients of living donor transplants.

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analytical methods
Analytical Methods
  • The effects of various factors on graft failure, death-censored graft failure, and death with function were analyzed for the living donor and cadaveric donor populations using Cox proportional hazards models.
  • The results include:
    • Trends in first-year graft survival
    • Trends in conditional half-lives.
    • Overall survival curves
    • Relative risks associated with each covariate.
  • All results are adjusted for all other covariates.

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population
Population
  • All first, renal-only transplants in the United States from 1995 to 2001 with known recipient age and known donor type:
    • N=76,467
      • Living Donor Transplants: 28,469
      • Cadaveric Donor Transplants: 47,998
  • Follow-up through 9/30/2002.

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trends in first year graft survival
Trends in First-Year Graft Survival

Graft Failure

Death-Censored Graft Failure

Death with Function

Cadaveric

Living

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trends in conditional half lives
Trends in Conditional* Half-Lives

Graft Failure

Death-Censored Graft Failure

Death with Function

*Conditional on 1 year graft survival

Cadaveric

Living

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estimated graft survival 1995 2001
Estimated Graft Survival 1995-2001

Graft Failure

Death-Censored Graft Failure

Death with Function

Cadaveric

Living

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clinical indicators
Clinical Indicators
  • Factors Associated with both cadaveric and living donor transplants
  • Factors associated with cadaveric transplants
  • Factors associated with living donor transplants

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clinical indicators recipient age
Clinical Indicators: Recipient Age

Graft Failure

Death-Censored Graft Failure

Death with Function

Cadaveric

Living

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clinical indicators recipient gender
Clinical Indicators: Recipient Gender

Graft Failure

Death-Censored Graft Failure

Death with Function

*

*

*

*

Cadaveric

Living

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* p< 0.05

clinical indicators recipient race
Clinical Indicators: Recipient Race

Graft Failure

Death-Censored Graft Failure

Death with Function

*

*

*

*

*

*

*

*

*

*

Cadaveric

Living

USRDS

* p<0.05

clinical indicators recipient hispanic ethnicity
Clinical Indicators: Recipient Hispanic Ethnicity

Graft Failure

Death-Censored Graft Failure

Death with Function

*

*

*

*

*

*

Cadaveric

Living

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* P < 0.05

clinical indicators primary cause of renal failure
Clinical Indicators:Primary Cause of Renal Failure

Graft Failure

Death-Censored Graft Failure

Death with Function

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

Cadaveric

Living

USRDS

* p < 0.05

clinical indicators pre transplant serology hepatitis
Clinical Indicators:Pre-transplant Serology: Hepatitis

Graft Failure

Death-Censored Graft Failure

Death with Function

*

*

*

*

*

*

Cadaveric

Living

USRDS

* p < 0.05

clinical indicators recipient education
Clinical Indicators: Recipient Education

Graft Failure

Death-Censored Graft Failure

Death with Function

*

*

*

*

*

Cadaveric

Living

USRDS

* p < 0.05

clinical indicators recipient employment
Clinical Indicators: Recipient Employment

Graft Failure

Death-Censored Graft Failure

Death with Function

*

*

*

*

*

*

Cadaveric

Living

USRDS

* p < 0.05

clinical indicators prior dialysis time
Clinical Indicators: Prior Dialysis Time

Graft Failure

Death-Censored Graft Failure

Death with Function

Cadaveric

Living

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clinical indicators donor age
Clinical Indicators: Donor Age

Graft Failure

Death-Censored Graft Failure

Death with Function

Cadaveric

Living

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clinical indicators donor gender
Clinical Indicators: Donor Gender

Graft Failure

Death-Censored Graft Failure

Death with Function

*

*

*

*

Cadaveric

Living

USRDS

* p<0.05

clinical indicators donor race
Clinical Indicators: Donor Race

Graft Failure

Death-Censored Graft Failure

Death with Function

*

*

*

*

*

*

*

Cadaveric

Living

USRDS

* p<0.05

clinical indicators hla mismatches
Clinical Indicators: HLA Mismatches

Graft Failure

Death-Censored Graft Failure

Death with Function

Cadaveric

Living

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clinical indicators recipient body mass index bmi
Clinical Indicators:Recipient Body Mass Index (BMI)

Graft Failure

Death-Censored Graft Failure

Death with Function

Cadaveric

Living

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clinical indicators pra
Clinical Indicators: PRA

Graft Failure

Death-Censored Graft Failure

Death with Function

*

*

*

Cadaveric

Living

USRDS

* p<0.05

clinical indicators cmv matching
Clinical Indicators: CMV Matching

Graft Failure

Death-Censored Graft Failure

Death with Function

*

*

*

*

*

*

*

*

*

Cadaveric

Living

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* p<0.05

clinical indicators1
Clinical Indicators
  • Factors Associated with both cadaveric and living donor transplants
  • Factors associated with cadaveric transplants
  • Factors associated with living donor transplants

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cadaveric specific clinical indicators donor traumatic cause of death
Cadaveric-Specific Clinical Indicators: Donor Traumatic Cause of Death

Graft Failure

Death-Censored Graft Failure

Death with Function

*

*

*

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* p<0.05

cadaveric specific clinical indicators cold ischemia time
Cadaveric-Specific Clinical Indicators:Cold Ischemia Time

Graft Failure

Death-Censored Graft Failure

Death with Function

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cadaveric specific clinical indicators donor co morbid conditions
Cadaveric-Specific Clinical Indicators:Donor Co-morbid Conditions

Graft Failure

Death-Censored Graft Failure

Death with Function

*

*

*

* p<0.05

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clinical indicators2
Clinical Indicators
  • Factors Associated with both cadaveric and living donor transplants
  • Factors associated with cadaveric transplants
  • Factors associated with living donor transplants

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living donor clinical indicators donor recipient relationship
Living Donor Clinical Indicators:Donor-Recipient Relationship

Graft Failure

Death-Censored Graft Failure

Death with Function

*

*

*

*

*

*

* p<0.05

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clinical indicators for transplant outcome summary and conclusions
Clinical Indicators for transplant Outcome: Summary and Conclusions

Clinical Indicators that promote allograft loss include:

  • Older age (recipient and donor)
  • Race and ethnicity (recipient and donor)
  • Education and employment status
  • Primary Cause of Renal Disease
  • Longer time on dialysis prior to transplant
  • Hepatitis C and CMV positivity
  • HLA mismatches

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