Development and validation of a prognostic index for allograft outcome in kidney recipients with transplant glomerulopathy
| Autor: | Darshana Dadhania, Dominique Desvaux, Surya V. Seshan, David Serur, Marie Matignon, Jun Lee, Philippe Grimbert, Thangamani Muthukumar, Pallavi Patri, John R. Lee, Choli Hartono |
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| Rok vydání: | 2015 |
| Předmět: |
Adult
Male medicine.medical_specialty kidney biopsy 030232 urology & nephrology 030230 surgery Severity of Illness Index Article 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine Postoperative Complications Internal medicine Severity of illness medicine Humans Kidney transplantation Creatinine Proteinuria business.industry Proportional hazards model Hazard ratio Graft Survival Transplant glomerulopathy Middle Aged medicine.disease Kidney Transplantation 3. Good health Surgery chemistry Nephrology Cohort Female Kidney Diseases medicine.symptom business chronic allograft nephropathy |
| Zdroj: | Kidney international |
| ISSN: | 1523-1755 |
| Popis: | We studied 92 patients with transplant glomerulopathy to develop a prognostic index based on the risk factors for allograft failure within five years of diagnosis (Development cohort). During 60 months (median) follow-up, 64 patients developed allograft failure. A chronic-inflammation score generated by combining Banff ci, ct and ti scores, serum creatinine and proteinuria at biopsy, were independent risk factors for allograft failure. Based on the Cox model, we developed a prognostic index and classified patients into risk groups. Compared to the low-risk group (median allograft survival over 60 months from diagnosis), patients in the medium risk group had a hazard ratio of 2.83 (median survival 25 months), while those in the high-risk group had a hazard ratio of 5.96 (median survival 3.7 months). We next evaluated the performance of the prognostic index in an independent external cohort of 47 patients with transplant glomerulopathy (Validation cohort). The hazard ratios were 2.18 (median survival 19 months) and 16.27 (median survival 1.6 months), respectively, for patients in the medium and high-risk groups, compared to the low-risk group (median survival 47 months). Our prognostic index model did well in measures of discrimination and calibration. Thus, risk stratification of transplant glomerulopathy based on our prognostic index may provide informative insight for both the patient and physician regarding prognosis and treatment. |
| Databáze: | OpenAIRE |
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