Immortal Time-Bias-Corrected Survival of Highly Sensitized Patients and HLA-desensitized Kidney Transplant Recipients
Autor: | Paolo Malvezzi, Béatrice Bardy, Gaelle Fiard, Thomas Jouve, Lionel Rostaing, Nicolas Terrier, Mélanie Daligault, Diane Giovannini, Bénédicte Janbon, Dominique Masson, Hamza Naciri Bennani, Antoine Metzger, Eloi Chevallier, Johan Noble, Mathilde Bugnazet, Q. Franquet |
---|---|
Rok vydání: | 2021 |
Předmět: |
Kidney
medicine.medical_specialty end-stage renal disease business.industry Mortality rate Hazard ratio Urology desensitization Renal function kidney transplantation Human leukocyte antigen medicine.disease End stage renal disease medicine.anatomical_structure HLA-incompatible patient survival Nephrology Clinical Research Medicine business kidney graft survival Survival analysis Kidney transplantation |
Zdroj: | Kidney International Reports |
ISSN: | 2468-0249 |
Popis: | Introduction In the setting of kidney transplantation (KT), we assessed the efficacy of desensitization and compared the survival of desensitized patients (HLA-incompatible KT) with similarly sensitized patients receiving HLA-compatible KT or sensitized patients still on a waiting list after adjusting for the usually unaccounted immortal time bias. Methods All patients in a French KT center on the waiting list between August 1994 and December 2019 with a high level of sensitization (panel-reactive antibodies [PRAs] ≥80%) were included. The primary outcome was all-cause mortality. A time-varying covariate Cox survival model was used to account for the immortal time bias. A landmark analysis was used as a sensitivity analysis. Results During the study period, 326 patients with high PRAs were followed, among which 147 (45%) remained on the waiting list at the time of last follow-up and 179 benefited from a KT. Thirty-six patients were desensitized, of which 30 received a kidney transplant, including eight deceased kidney donors. There were no differences in mortality rates between desensitized KT patients, nondesensitized KT patients, and waitlisted patients after adjusting for immortal time bias (hazard ratio [HR] = 0.48, P = 0.22). Death-censored graft survival was similar between desensitized and nondesensitized KT patients (HR = 0.92, P = 0.88 adjusting for donor age >65 years, donor status, and time on the waiting list). Mean estimated glomerular filtration rate at 1 year post-KT was similar for desensitized KT patients (53.3 ± 21 vs. 53.6 ± 21 ml/min per 1.73 m2 for nondesensitized patients; P = 0.95). Conclusions HLA-desensitization was effective for highly sensitized patients and gave access to KT without detrimental effects on patient or graft survival rates. Graphical abstract |
Databáze: | OpenAIRE |
Externí odkaz: |