Mortality Prediction after the First Year of Kidney Transplantation: An Observational Study on Two European Cohorts.

Marine Lorent,Marine Lorent,Marine Lorent,Marine Lorent,Michèle Kessler,Jürg Steiger,Marc Ladrière,Michael T Koller,Christophe Legendre,Christophe Legendre,Christophe Legendre,Christophe Legendre,Christophe Legendre,Yohann Foucher,Yohann Foucher,Yohann Foucher,Yohann Foucher,Valérie Garrigue,Fanny Buron,Henri Kreis,Henri Kreis,Henri Kreis,Henri Kreis,Henri Kreis,Manuel Pascual,Lionel Rostaing,Lionel Rostaing,Dela Golshayan,Emmanuel Morelon,Katy Trébern-Launay,Katy Trébern-Launay,Katy Trébern-Launay,Katy Trébern-Launay,Nassim Kamar,Nassim Kamar,Magali Giral,Magali Giral,Magali Giral,Georges Mourad

doi:10.1371/journal.pone.0155278

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.

Highlights

Kidney transplantation (KT) is known to be the treatment of choice for end-stage renal disease
We currently proceed to such adaptation by video-conferencing in the frame of a French multicenter randomized study [7], in which the visits frequency is driven by the longterm risk of return to dialysis evaluated by a decision making tool so-called: “Kidney Transplant Failure Score (KTFS)” and computed at 1-year [8]
The evaluation of the risk to return to dialysis can be achieved by using the KTFS or other scoring systems [8, 27, 28]

Summary

Introduction

Kidney transplantation (KT) is known to be the treatment of choice for end-stage renal disease. On an individual level, the mortality risk varies between patients, resulting in a heterogeneity of the benefit in relation to transplantation [5]. This is important with regard to the ageing of recipients, as in the United States for instance where the proportion of candidates on the KT waiting list over the age of 65 years has increased during the past decade from 10 to 18% [6]. In addition to the prediction of the risk of return to dialysis, we hypothesized that the combined evaluation with the risk of long-term mortality could improve the risk stratification for a better medical follow-up adaptation

Objectives

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Results

Conclusion