Early Graft Loss Following Transplantation From Expanded Criteria Donors
Background. Expanded criteria donor (ECD) kidneys are associated with higher graft loss rates than standard criteria donor kidneys. We sought to determine factors associated with early graft loss and their discrimination ability for this outcome compared with kidney donor risk index. Methods. Data w...
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ftdoajarticles:oai:doaj.org/article:e56920644a164ebcbebfa977e38a7118 2023-05-15T16:16:52+02:00 Early Graft Loss Following Transplantation From Expanded Criteria Donors Nicholas G. Larkins, PhD Germaine Wong, PhD David W. Johnson, PhD Carmel Hawley, FRACP Armando Teixeira-Pinto, PhD Henry Pleass, MD Helen Pilmore, PhD Wai H. Lim, PhD 2021-11-01T00:00:00Z https://doi.org/10.1097/TXD.0000000000001235 https://doaj.org/article/e56920644a164ebcbebfa977e38a7118 EN eng Wolters Kluwer http://journals.lww.com/transplantationdirect/fulltext/10.1097/TXD.0000000000001235 https://doaj.org/toc/2373-8731 2373-8731 doi:10.1097/TXD.0000000000001235 https://doaj.org/article/e56920644a164ebcbebfa977e38a7118 Transplantation Direct, Vol 7, Iss 11, p e783 (2021) Surgery RD1-811 article 2021 ftdoajarticles https://doi.org/10.1097/TXD.0000000000001235 2022-12-31T14:34:46Z Background. Expanded criteria donor (ECD) kidneys are associated with higher graft loss rates than standard criteria donor kidneys. We sought to determine factors associated with early graft loss and their discrimination ability for this outcome compared with kidney donor risk index. Methods. Data were extracted from the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) for ECD transplants between 1997 and 2014. The primary outcome was early graft loss (all-cause graft loss within 3 y of transplantation). Death-censored graft loss was substituted as a sensitivity analysis. Era-adjusted odds ratios were calculated by multivariable logistic regression for donor, recipient, and transplant factors available at transplantation. Discrimination was assessed by c-statistic, with 95% confidence intervals (CIs) calculated by bootstrapping. Results. Of 2152 ECD kidney transplants, early graft loss occurred in 406 (19%) and was associated with recipient diabetes, smoking, First Nations recipients, and oliguria. Of factors defining ECD (age, elevated terminal creatinine, hypertension, death from cerebrovascular accident), all but mode of death were associated with early graft loss. The multivariable model, including known donor, recipient, and transplant factors, was moderately good at predicting early graft loss (c-statistic 0.65; 95% CI, 0.62-0.68). Recipient factors (c-statistic 0.62; 95% CI, 0.59-0.65) performed equally well compared with donor factors (c-statistic 0.60; 95% CI, 0.57-0.64) or the kidney donor risk index (c-statistic 0.60; 95% CI, 0.56-0.63). Conclusions. Early graft loss occurs in approximately one-fifth of ECD kidney transplants. The discriminatory value of commonly used recipient, donor, and transplant factors are approximately comparable and limited. Article in Journal/Newspaper First Nations Directory of Open Access Journals: DOAJ Articles New Zealand Transplantation Direct 7 11 e783 |
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Directory of Open Access Journals: DOAJ Articles |
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English |
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Surgery RD1-811 |
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Surgery RD1-811 Nicholas G. Larkins, PhD Germaine Wong, PhD David W. Johnson, PhD Carmel Hawley, FRACP Armando Teixeira-Pinto, PhD Henry Pleass, MD Helen Pilmore, PhD Wai H. Lim, PhD Early Graft Loss Following Transplantation From Expanded Criteria Donors |
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Surgery RD1-811 |
description |
Background. Expanded criteria donor (ECD) kidneys are associated with higher graft loss rates than standard criteria donor kidneys. We sought to determine factors associated with early graft loss and their discrimination ability for this outcome compared with kidney donor risk index. Methods. Data were extracted from the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) for ECD transplants between 1997 and 2014. The primary outcome was early graft loss (all-cause graft loss within 3 y of transplantation). Death-censored graft loss was substituted as a sensitivity analysis. Era-adjusted odds ratios were calculated by multivariable logistic regression for donor, recipient, and transplant factors available at transplantation. Discrimination was assessed by c-statistic, with 95% confidence intervals (CIs) calculated by bootstrapping. Results. Of 2152 ECD kidney transplants, early graft loss occurred in 406 (19%) and was associated with recipient diabetes, smoking, First Nations recipients, and oliguria. Of factors defining ECD (age, elevated terminal creatinine, hypertension, death from cerebrovascular accident), all but mode of death were associated with early graft loss. The multivariable model, including known donor, recipient, and transplant factors, was moderately good at predicting early graft loss (c-statistic 0.65; 95% CI, 0.62-0.68). Recipient factors (c-statistic 0.62; 95% CI, 0.59-0.65) performed equally well compared with donor factors (c-statistic 0.60; 95% CI, 0.57-0.64) or the kidney donor risk index (c-statistic 0.60; 95% CI, 0.56-0.63). Conclusions. Early graft loss occurs in approximately one-fifth of ECD kidney transplants. The discriminatory value of commonly used recipient, donor, and transplant factors are approximately comparable and limited. |
format |
Article in Journal/Newspaper |
author |
Nicholas G. Larkins, PhD Germaine Wong, PhD David W. Johnson, PhD Carmel Hawley, FRACP Armando Teixeira-Pinto, PhD Henry Pleass, MD Helen Pilmore, PhD Wai H. Lim, PhD |
author_facet |
Nicholas G. Larkins, PhD Germaine Wong, PhD David W. Johnson, PhD Carmel Hawley, FRACP Armando Teixeira-Pinto, PhD Henry Pleass, MD Helen Pilmore, PhD Wai H. Lim, PhD |
author_sort |
Nicholas G. Larkins, PhD |
title |
Early Graft Loss Following Transplantation From Expanded Criteria Donors |
title_short |
Early Graft Loss Following Transplantation From Expanded Criteria Donors |
title_full |
Early Graft Loss Following Transplantation From Expanded Criteria Donors |
title_fullStr |
Early Graft Loss Following Transplantation From Expanded Criteria Donors |
title_full_unstemmed |
Early Graft Loss Following Transplantation From Expanded Criteria Donors |
title_sort |
early graft loss following transplantation from expanded criteria donors |
publisher |
Wolters Kluwer |
publishDate |
2021 |
url |
https://doi.org/10.1097/TXD.0000000000001235 https://doaj.org/article/e56920644a164ebcbebfa977e38a7118 |
geographic |
New Zealand |
geographic_facet |
New Zealand |
genre |
First Nations |
genre_facet |
First Nations |
op_source |
Transplantation Direct, Vol 7, Iss 11, p e783 (2021) |
op_relation |
http://journals.lww.com/transplantationdirect/fulltext/10.1097/TXD.0000000000001235 https://doaj.org/toc/2373-8731 2373-8731 doi:10.1097/TXD.0000000000001235 https://doaj.org/article/e56920644a164ebcbebfa977e38a7118 |
op_doi |
https://doi.org/10.1097/TXD.0000000000001235 |
container_title |
Transplantation Direct |
container_volume |
7 |
container_issue |
11 |
container_start_page |
e783 |
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1766002719846301696 |