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Clinical Indicators of Renal Allograft Loss

Clinical Indicators of Renal Allograft Loss. Lawrence Y.C. Agodoa, MD FACP Jon J. Snyder, MS Bertram L. Kasiske, MD Allan J. Collins, MD FACP United States Renal Data System Department of Health and Human Services National Institutes of Health

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Clinical Indicators of Renal Allograft Loss

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  1. Clinical Indicators of Renal Allograft Loss Lawrence Y.C. Agodoa, MD FACP Jon J. Snyder, MS Bertram L. Kasiske, MD Allan J. Collins, MD FACP United States Renal Data System Department of Health and Human Services National Institutes of Health National Institute of Diabetes and Digestive and Kidney Diseases National Institute of Diabetes and Digestive and Kidney Diseases

  2. Time Trends in Transplants in the US USRDS

  3. Renal Allograft Survival Probabilities, US; adjusted for age, gender, race and primary disease USRDS

  4. Causes of Renal Allograft Loss Acute – Mechanical - Immune mediated Early - Immune mediated - Non-immune Late - Non-immune I M M U N O L O G I C Clinical Indicators NON- IMMUNOLOGIC USRDS

  5. Study Objectives • Determine how various clinical indicators affect graft survival in the cadaveric and living donor transplant recipients. • Three outcomes were considered: • Graft failure (including death) • Death-censored graft failure (graft loss without death) • Death with functioning graft • Due to factors unique to cadaveric vs. living donor recipients, cadaveric transplant recipients are analyzed separately from recipients of living donor transplants. USRDS

  6. Analytical Methods • The effects of various factors on graft failure, death-censored graft failure, and death with function were analyzed for the living donor and cadaveric donor populations using Cox proportional hazards models. • The results include: • Trends in first-year graft survival • Trends in conditional half-lives. • Overall survival curves • Relative risks associated with each covariate. • All results are adjusted for all other covariates. USRDS

  7. Population • All first, renal-only transplants in the United States from 1995 to 2001 with known recipient age and known donor type: • N=76,467 • Living Donor Transplants: 28,469 • Cadaveric Donor Transplants: 47,998 • Follow-up through 9/30/2002. USRDS

  8. Trends in First-Year Graft Survival Graft Failure Death-Censored Graft Failure Death with Function Cadaveric Living USRDS

  9. Trends in Conditional* Half-Lives Graft Failure Death-Censored Graft Failure Death with Function *Conditional on 1 year graft survival Cadaveric Living USRDS

  10. Estimated Graft Survival 1995-2001 Graft Failure Death-Censored Graft Failure Death with Function Cadaveric Living USRDS

  11. Clinical Indicators • Factors Associated with both cadaveric and living donor transplants • Factors associated with cadaveric transplants • Factors associated with living donor transplants USRDS

  12. Clinical Indicators: Recipient Age Graft Failure Death-Censored Graft Failure Death with Function Cadaveric Living USRDS

  13. Clinical Indicators: Recipient Gender Graft Failure Death-Censored Graft Failure Death with Function * * * * Cadaveric Living USRDS * p< 0.05

  14. Clinical Indicators: Recipient Race Graft Failure Death-Censored Graft Failure Death with Function * * * * * * * * * * Cadaveric Living USRDS * p<0.05

  15. Clinical Indicators: Recipient Hispanic Ethnicity Graft Failure Death-Censored Graft Failure Death with Function * * * * * * Cadaveric Living USRDS * P < 0.05

  16. Clinical Indicators:Primary Cause of Renal Failure Graft Failure Death-Censored Graft Failure Death with Function * * * * * * * * * * * * * * * * * * * Cadaveric Living USRDS * p < 0.05

  17. Clinical Indicators:Pre-transplant Serology: Hepatitis Graft Failure Death-Censored Graft Failure Death with Function * * * * * * Cadaveric Living USRDS * p < 0.05

  18. Clinical Indicators: Recipient Education Graft Failure Death-Censored Graft Failure Death with Function * * * * * Cadaveric Living USRDS * p < 0.05

  19. Clinical Indicators: Recipient Employment Graft Failure Death-Censored Graft Failure Death with Function * * * * * * Cadaveric Living USRDS * p < 0.05

  20. Clinical Indicators: Prior Dialysis Time Graft Failure Death-Censored Graft Failure Death with Function Cadaveric Living USRDS

  21. Clinical Indicators: Donor Age Graft Failure Death-Censored Graft Failure Death with Function Cadaveric Living USRDS

  22. Clinical Indicators: Donor Gender Graft Failure Death-Censored Graft Failure Death with Function * * * * Cadaveric Living USRDS * p<0.05

  23. Clinical Indicators: Donor Race Graft Failure Death-Censored Graft Failure Death with Function * * * * * * * Cadaveric Living USRDS * p<0.05

  24. Clinical Indicators: HLA Mismatches Graft Failure Death-Censored Graft Failure Death with Function Cadaveric Living USRDS

  25. Clinical Indicators:Recipient Body Mass Index (BMI) Graft Failure Death-Censored Graft Failure Death with Function Cadaveric Living USRDS

  26. Clinical Indicators: PRA Graft Failure Death-Censored Graft Failure Death with Function * * * Cadaveric Living USRDS * p<0.05

  27. Clinical Indicators: CMV Matching Graft Failure Death-Censored Graft Failure Death with Function * * * * * * * * * Cadaveric Living USRDS * p<0.05

  28. Clinical Indicators • Factors Associated with both cadaveric and living donor transplants • Factors associated with cadaveric transplants • Factors associated with living donor transplants USRDS

  29. Cadaveric-Specific Clinical Indicators: Donor Traumatic Cause of Death Graft Failure Death-Censored Graft Failure Death with Function * * * USRDS * p<0.05

  30. Cadaveric-Specific Clinical Indicators:Cold Ischemia Time Graft Failure Death-Censored Graft Failure Death with Function USRDS

  31. Cadaveric-Specific Clinical Indicators:Donor Co-morbid Conditions Graft Failure Death-Censored Graft Failure Death with Function * * * * p<0.05 USRDS

  32. Clinical Indicators • Factors Associated with both cadaveric and living donor transplants • Factors associated with cadaveric transplants • Factors associated with living donor transplants USRDS

  33. Living Donor Clinical Indicators:Donor-Recipient Relationship Graft Failure Death-Censored Graft Failure Death with Function * * * * * * * p<0.05 USRDS

  34. Clinical Indicators for transplant Outcome: Summary and Conclusions Clinical Indicators that promote allograft loss include: • Older age (recipient and donor) • Race and ethnicity (recipient and donor) • Education and employment status • Primary Cause of Renal Disease • Longer time on dialysis prior to transplant • Hepatitis C and CMV positivity • HLA mismatches USRDS

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