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Law, Jonathan P, Borrows, Richard, McNulty, David, Sharif, Adnan and Ferro, Charles J (2021) Early renal function trajectories, cytomegalovirus serostatus and long-term graft outcomes in kidney transplant recipients. BMC nephrology, 22 (1). p. 102. ISSN 1471-2369. This article is available to all UHB staff and students via ASK Discovery tool http://tinyurl.com/z795c8c by using their UHB Athens login IDs
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Abstract
BACKGROUND
Improved recognition of factors influencing graft survival has led to better short-term kidney transplant outcomes. However, efforts to prevent long-term graft decline and improve graft survival have seen more modest improvements. The adoption of electronic health records has enabled better recording and identification of donor-recipient factors through the use of modern statistical techniques. We have previously shown in a prevalent renal transplant population that episodes of rapid deterioration are associated with graft loss.
METHODS
Estimated glomerular filtration rates (eGFR) between 3 and 27 months after transplantation were collected from 310 kidney transplant recipients. We utilised a Bayesian approach to estimate the most likely eGFR trajectory as a smooth curve from an average of 10,000 Monte Carlo samples. The probability of having an episode of rapid deterioration (decline greater than 5 ml/min/1.73 m per year in any 1-month period) was calculated. Graft loss and mortality data was collected over a median follow-up period of 8 years. Factors associated with having an episode of rapid deterioration and associations with long-term graft loss were explored.
RESULTS
In multivariable Cox Proportional Hazard analysis, a probability greater than 0.8 of rapid deterioration was associated with long-term death-censored graft loss (Hazard ratio 2.17; 95% Confidence intervals [CI] 1.04-4.55). In separate multivariable logistic regression models, cytomegalovirus (CMV) serostatus donor positive to recipient positive (Odds ratio [OR] 3.82; 95%CI 1.63-8.97), CMV donor positive (OR 2.06; 95%CI 1.15-3.68), and CMV recipient positive (OR 2.03; 95%CI 1.14-3.60) were associated with having a greater than 0.8 probability of an episode of rapid deterioration.
CONCLUSIONS
Early episodes of rapid deterioration are associated with long-term death-censored graft loss and are associated with cytomegalovirus seropositivity. Further study is required to better manage these potentially modifiable risks factors and improve long-term graft survival.
| Item Type: | Article |
|---|---|
| Additional Information: | This article is available to all UHB staff and students via ASK Discovery tool http://tinyurl.com/z795c8c by using their UHB Athens login IDs |
| Subjects: | W Public health. Health statistics. Occupational health. Health education WG Cardiovascular system. Cardiology WJ Urogenital system. Urology |
| Divisions: | Planned IP Care > Urology |
| Related URLs: | |
| Depositing User: | Jamie Edgar |
| Date Deposited: | 30 Mar 2021 09:20 |
| Last Modified: | 30 Mar 2021 09:20 |
| URI: | http://www.repository.uhblibrary.co.uk/id/eprint/4146 |
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