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Lorent M, Giral M, Pascual M, Koller MT, Steiger J, Trébern-Launay K, Legendre C, Kreis H, Mourad G, Garrigue V, Rostaing L, Kamar N, Kessler M, Ladrière M, Morelon E, Buron F, Golshayan D, Foucher Y. Mortality Prediction after the First Year of Kidney Transplantation: An Observational Study on Two European Cohorts. PLoS One 2016; 11:e0155278. [PMID: 27152510 PMCID: PMC4859488 DOI: 10.1371/journal.pone.0155278] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 04/26/2016] [Indexed: 11/18/2022] Open
Abstract
After the first year post transplantation, prognostic mortality scores in kidney transplant recipients can be useful for personalizing medical management. We developed a new prognostic score based on 5 parameters and computable at 1-year post transplantation. The outcome was the time between the first anniversary of the transplantation and the patient’s death with a functioning graft. Afterwards, we appraised the prognostic capacities of this score by estimating time-dependent Receiver Operating Characteristic (ROC) curves from two prospective and multicentric European cohorts: the DIVAT (Données Informatisées et VAlidées en Transplantation) cohort composed of patients transplanted between 2000 and 2012 in 6 French centers; and the STCS (Swiss Transplant Cohort Study) cohort composed of patients transplanted between 2008 and 2012 in 6 Swiss centers. We also compared the results with those of two existing scoring systems: one from Spain (Hernandez et al.) and one from the United States (the Recipient Risk Score, RRS, Baskin-Bey et al.). From the DIVAT validation cohort and for a prognostic time at 10 years, the new prognostic score (AUC = 0.78, 95%CI = [0.69, 0.85]) seemed to present significantly higher prognostic capacities than the scoring system proposed by Hernandez et al. (p = 0.04) and tended to perform better than the initial RRS (p = 0.10). By using the Swiss cohort, the RRS and the the new prognostic score had comparable prognostic capacities at 4 years (AUC = 0.77 and 0.76 respectively, p = 0.31). In addition to the current available scores related to the risk to return in dialysis, we recommend to further study the use of the score we propose or the RRS for a more efficient personalized follow-up of kidney transplant recipients.
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Affiliation(s)
- Marine Lorent
- EA 4275 SPHERE—Biostatistics, Clinical Research and Pharmaco-Epidemiology. Nantes University, Nantes, France
- Transplantation, Urology and Nephrology Institute (ITUN)—INSERM U1064, CHU Nantes, Nantes, France
| | - Magali Giral
- Transplantation, Urology and Nephrology Institute (ITUN)—INSERM U1064, CHU Nantes, Nantes, France
- CIC Biotherapy, CHU Nantes, Nantes, France
- * E-mail:
| | - Manuel Pascual
- Transplantation Center, CHUV and University of Lausanne, Lausanne, Switzerland
| | - Michael T. Koller
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland
| | - Jürg Steiger
- Transplantation Immunology and Nephrology, University Hospital Basel, Basel, Switzerland
| | - Katy Trébern-Launay
- EA 4275 SPHERE—Biostatistics, Clinical Research and Pharmaco-Epidemiology. Nantes University, Nantes, France
- Transplantation, Urology and Nephrology Institute (ITUN)—INSERM U1064, CHU Nantes, Nantes, France
| | - Christophe Legendre
- Service de Transplantation Rénale et de Soins Intensifs, Hôpital Necker, APHP Paris, Paris, France
- Universités Paris Descartes et Sorbonne Paris Cité, Paris, France
| | - Henri Kreis
- Service de Transplantation Rénale et de Soins Intensifs, Hôpital Necker, APHP Paris, Paris, France
- Universités Paris Descartes et Sorbonne Paris Cité, Paris, France
| | - Georges Mourad
- Service de Néphrologie-Transplantation, Hôpital Lapeyronie, Montpellier, France
| | - Valérie Garrigue
- Service de Néphrologie-Transplantation, Hôpital Lapeyronie, Montpellier, France
| | - Lionel Rostaing
- Service de Néphrologie, HTA, Dialyse et Transplantation d'Organes, CHU Rangueil, Toulouse, France
- Université Paul Sabatier, Toulouse, France
| | - Nassim Kamar
- Service de Néphrologie, HTA, Dialyse et Transplantation d'Organes, CHU Rangueil, Toulouse, France
- Université Paul Sabatier, Toulouse, France
| | - Michèle Kessler
- Service de Transplantation Rénale, CHU Brabois, Nancy, France
| | - Marc Ladrière
- Service de Transplantation Rénale, CHU Brabois, Nancy, France
| | - Emmanuel Morelon
- Service de Néphrologie, Transplantation et Immunologie Clinique, Hôpital Edouard Herriot, Lyon, France
| | - Fanny Buron
- Service de Néphrologie, Transplantation et Immunologie Clinique, Hôpital Edouard Herriot, Lyon, France
| | - Dela Golshayan
- Transplantation Center, CHUV and University of Lausanne, Lausanne, Switzerland
| | - Yohann Foucher
- EA 4275 SPHERE—Biostatistics, Clinical Research and Pharmaco-Epidemiology. Nantes University, Nantes, France
- Transplantation, Urology and Nephrology Institute (ITUN)—INSERM U1064, CHU Nantes, Nantes, France
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