Dataset Information

Development of a novel linear model for predicting recipient's post-transplant serum creatinine level after living donor kidney transplantation: A multicenter cross-validation study.

ABSTRACT:

Background

This study was designed to develop and cross-validate a statistical model for predicting post-transplant serum creatinine of living donor kidney transplantation.

Materials and methods

Adult recipients of living donor kidney transplantation from August 2012 to October 2017 at Samsung Medical Center (SMC) and Seoul National University Hospital (SNUH) with normal post-transplant protocol biopsy were included for modelling. Demographic data including recipient and donor's sex, age, body measurements and comorbidities, pre-transplant donor serum creatinine, graft weight, post-transplant recipient serum creatinine and the result of protocol biopsy were collected. Multivariate linear regression analysis was performed for developing the model based on SMC cohort. Internal validation was performed using leave-one-out cross-validation with the same cohort. External validation using leave-one-out cross-validation was performed based on the cohort of SNUH.

Results

A total of 238 and 191 recipients were included from SMC and SNUH, respectively. The prediction model included recipient's sex (? = 0.228, P<0.001), height (? = 0.007, P<0.001), and weight (? = 0.006, P<0.001), donor's age (? = 0.004, P<0.001), height (? = -0.007, P<0.001), pre-transplant serum Cr (? = 0.377, P<0.001) and graft weight (? = -0.002, P<0.001). The model showed R2 of 0.708, root mean square error of prediction (RMSEP) of 0.161 and intraclass correlation coefficient (ICC) of 0.83. The internal validation showed predicted ICC of 0.82, RMSEP of 0.161, and accuracy was calculated 0.895. The external validation showed predicted ICC of 0.78, RMSEP of 0.170, and accuracy was calculated 0.876.

Conclusions

The linear prediction model based on body measurement and donor serum creatinine and graft weight showed a high accuracy in cross-validation.

SUBMITTER: Rhu J

PROVIDER: S-EPMC6472729 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

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Publications

Development of a novel linear model for predicting recipient's post-transplant serum creatinine level after living donor kidney transplantation: A multicenter cross-validation study.

Rhu Jinsoo J Kim Sung Joo SJ Lee Kyo Won KW Park Jae Berm JB Kim Kyunga K Yoo Heejin H Mo Hyejin H Choi Chanjoong C Min Sang-Il SI Ha Jongwon J

PloS one 20190418 4

<h4>Background</h4>This study was designed to develop and cross-validate a statistical model for predicting post-transplant serum creatinine of living donor kidney transplantation.<h4>Materials and methods</h4>Adult recipients of living donor kidney transplantation from August 2012 to October 2017 at Samsung Medical Center (SMC) and Seoul National University Hospital (SNUH) with normal post-transplant protocol biopsy were included for modelling. Demographic data including recipient and donor's s ...[more]

PMID: 30998680

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Project description:Background and objectivesThe prognostic value of preformed donor-specific HLA antibodies (DSA), which are only detectable by sensitive methods, remains controversial for kidney transplantation.Design, setting, participants, & measurementsThe outcome of 4233 consecutive kidney transplants performed between 2012 and 2015 in 18 German transplant centers was evaluated. Most centers used a stepwise pretransplant antibody screening with bead array tests and differentiation of positive samples by single antigen assays. Using these screening results, DSA against HLA-A, -B, -C, -DRB1 and -DQB1 were determined. Data on clinical outcome and possible covariates were collected retrospectively.ResultsPretransplant DSA were associated with lower overall graft survival, with a hazard ratio of 2.53 for living donation (95% confidence interval [95% CI], 1.49 to 4.29; P<0.001) and 1.59 for deceased donation (95% CI, 1.21 to 2.11; P=0.001). ABO-incompatible transplantation was associated with worse graft survival (hazard ratio, 2.09; 95% CI, 1.33 to 3.27; P=0.001) independent from DSA. There was no difference between DSA against class 1, class 2, or both. Stratification into DSA <3000 medium fluorescence intensity (MFI) and DSA ≥3000 MFI resulted in overlapping survival curves. Therefore, separate analyses were performed for 3-month and long-term graft survival. Although DSA <3000 MFI tended to be associated with both lower 3-month and long-term transplant survival in deceased donation, DSA ≥3000 MFI were only associated with worse long-term transplant survival in deceased donation. In living donation, only strong DSA were associated with reduced graft survival in the first 3 months, but both weak and strong DSA were associated with reduced long-term graft survival. A higher incidence of antibody-mediated rejection within 6 months was only associated with DSA ≥3000 MFI.ConclusionsPreformed DSA were associated with an increased risk for graft loss in kidney transplantation, which was greater in living than in deceased donation. Even weak DSA <3000 MFI were associated with worse graft survival. This association was stronger in living than deceased donation.

Project description:Living donor kidney transplantation (LDKT) offers better quality of life and clinical outcomes, including patient survival, compared with remaining on dialysis or receiving a deceased donor kidney transplant. Although LDKT education within transplant centers for both potential recipients and living donors is very important, outreach and education to kidney patients in settings other than transplant centers and to the general public is also critical to increase access to this highly beneficial treatment. In June 2014, the American Society of Transplantation's Live Donor Community of Practice, with the support of 10 additional sponsors, convened a consensus conference to determine best practices in LDKT, including a workgroup focused on developing a set of recommendations for optimizing outreach and LDKT education outside of transplant centers. Members of this workgroup performed a structured literature review, conducted teleconference meetings, and met in person at the 2-day conference. Their efforts resulted in consensus around the following recommendations. First, preemptive transplantation should be promoted through increased LDKT education by primary care physicians and community nephrologists. Second, dialysis providers should be trained to educate their own patients about LDKT and deceased donor kidney transplantation. Third, partnerships between community organizations, organ procurement organizations, religious organizations, and transplant centers should be fostered to support transplantation. Fourth, use of technology should be improved or expanded to better educate kidney patients and their support networks. Fifth, LDKT education and outreach should be improved for kidney patients in rural areas. Finally, a consensus-driven, evidence-based public message about LDKT should be developed. Discussion of the effect and potential for implementation around each recommendation is featured, particularly regarding reducing racial and socioeconomic disparities in access to LDKT. To accomplish these recommendations, the entire community of professionals and organizations serving kidney patients must work collaboratively toward ensuring accurate, comprehensive, and up-to-date LDKT education for all patients, thereby reducing barriers to LDKT access and increasing LDKT rates.

Project description:Adult-to-adult living donors and recipients were studied to characterize patterns of liver growth and identify associated factors in a multicenter study. Three hundred and fifty donors and 353 recipients in the Adult-to-Adult Living Donor Liver Transplantation Cohort Study (A2ALL) receiving transplants between March 2003 and February 2010 were included. Potential predictors of 3-month liver volume included total and standard liver volumes (TLV and SLV), Model for End-Stage Liver Disease (MELD) score (in recipients), the remnant and graft size, remnant-to-donor and graft-to-recipient weight ratios (RDWR and GRWR), remnant/TLV, and graft/SLV. Among donors, 3-month absolute growth was 676 ± 251 g (mean ± SD), and percentage reconstitution was 80% ± 13%. Among recipients, GRWR was 1.3% ± 0.4% (8 < 0.8%). Graft weight was 60% ± 13% of SLV. Three-month absolute growth was 549 ± 267 g, and percentage reconstitution was 93% ± 18%. Predictors of greater 3-month liver volume included larger patient size (donors and recipients), larger graft volume (recipients), and larger TLV (donors). Donors with the smallest remnant/TLV ratios had larger than expected growth but also had higher postoperative bilirubin and international normalized ratio at 7 and 30 days. In a combined donor-recipient analysis, donors had smaller 3-month liver volumes than recipients adjusted for patient size, remnant or graft volume, and TLV or SLV (P = 0.004). Recipient graft failure in the first 90 days was predicted by poor graft function at day 7 (HR = 4.50, P = 0.001) but not by GRWR or graft fraction (P > 0.90 for each). Both donors and recipients had rapid yet incomplete restoration of tissue mass in the first 3 months, and this confirmed previous reports. Recipients achieved a greater percentage of expected total volume. Patient size and recipient graft volume significantly influenced 3-month volumes. Importantly, donor liver volume is a critical predictor of the rate of regeneration, and donor remnant fraction affects postresection function. Liver Transpl 21:79-88, 2015. © 2014 AASLD.

Dataset Information

Development of a novel linear model for predicting recipient's post-transplant serum creatinine level after living donor kidney transplantation: A multicenter cross-validation study.

Background

Materials and methods

Results

Conclusions

Publications

Development of a novel linear model for predicting recipient's post-transplant serum creatinine level after living donor kidney transplantation: A multicenter cross-validation study.

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