Death With Function and Graft Failure After Kidney Transplantation: Risk Factors at Baseline Suggest New Approaches to Management

Massini A. Merzkani, MD; Andrew J. Bentall, MD; Byron H. Smith, PhD; Xiomara Benavides Lopez, MD; Matthew R. D’Costa, MD; Walter D. Park, BS; Walter K. Kremers, PhD; Naim Issa, MD; Andrew D. Rule, MD; Harini Chakkera, MD; Kunam Reddy, MD; Hasan Khamash, MD; Hani M. Wadei, MD; Martin Mai, MD; Mariam P. Alexander, MD; Hatem Amer, MD; Aleksandra Kukla, MD; Mireille El Ters, MD; Carrie A. Schinstock, MD; Manish J. Gandhi, MD; Raymond Heilman, MD; Mark D. Stegall, MD

doi:10.1097/TXD.0000000000001273

Transplantation Direct (Feb 2022)

Death With Function and Graft Failure After Kidney Transplantation: Risk Factors at Baseline Suggest New Approaches to Management

Massini A. Merzkani, MD,
Andrew J. Bentall, MD,
Byron H. Smith, PhD,
Xiomara Benavides Lopez, MD,
Matthew R. D’Costa, MD,
Walter D. Park, BS,
Walter K. Kremers, PhD,
Naim Issa, MD,
Andrew D. Rule, MD,
Harini Chakkera, MD,
Kunam Reddy, MD,
Hasan Khamash, MD,
Hani M. Wadei, MD,
Martin Mai, MD,
Mariam P. Alexander, MD,
Hatem Amer, MD,
Aleksandra Kukla, MD,
Mireille El Ters, MD,
Carrie A. Schinstock, MD,
Manish J. Gandhi, MD,
Raymond Heilman, MD,
Mark D. Stegall, MD

Affiliations

Massini A. Merzkani, MD: 1 Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN.
Andrew J. Bentall, MD: 1 Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN.
Byron H. Smith, PhD: 3 Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN.
Xiomara Benavides Lopez, MD: 2 William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN.
Matthew R. D’Costa, MD: 1 Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN.
Walter D. Park, BS: 2 William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN.
Walter K. Kremers, PhD: 3 Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN.
Naim Issa, MD: 1 Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN.
Andrew D. Rule, MD: 1 Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN.
Harini Chakkera, MD: 4 Division of Nephrology and Hypertension, Mayo Clinic, Scottsdale, AZ.
Kunam Reddy, MD: 4 Division of Nephrology and Hypertension, Mayo Clinic, Scottsdale, AZ.
Hasan Khamash, MD: 4 Division of Nephrology and Hypertension, Mayo Clinic, Scottsdale, AZ.
Hani M. Wadei, MD: 5 Division of Transplant Surgery, Mayo Clinic, Scottsdale, AZ.
Martin Mai, MD: 5 Division of Transplant Surgery, Mayo Clinic, Scottsdale, AZ.
Mariam P. Alexander, MD: 6 Division of Nephrology and Hypertension, Mayo Clinic, Jacksonville, FL.
Hatem Amer, MD: 1 Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN.
Aleksandra Kukla, MD: 1 Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN.
Mireille El Ters, MD: 1 Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN.
Carrie A. Schinstock, MD: 1 Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN.
Manish J. Gandhi, MD: 7 Division and Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN.
Raymond Heilman, MD: 4 Division of Nephrology and Hypertension, Mayo Clinic, Scottsdale, AZ.
Mark D. Stegall, MD: 2 William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN.

DOI: https://doi.org/10.1097/TXD.0000000000001273
Journal volume & issue: Vol. 8, no. 2
p. e1273

Abstract

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Background. Improving both patient and graft survival after kidney transplantation are major unmet needs. The goal of this study was to assess risk factors for specific causes of graft loss to determine to what extent patients who develop either death with a functioning graft (DWFG) or graft failure (GF) have similar baseline risk factors for graft loss. Methods. We retrospectively studied all solitary renal transplants performed between January 1, 2006, and December 31, 2018, at 3 centers and determined the specific causes of DWFG and GF. We examined outcomes in different subgroups using competing risk estimates and cause-specific Cox models. Results. Of the 5752 kidney transplants, graft loss occurred in 21.6% (1244) patients, including 12.0% (691) DWFG and 9.6% (553) GF. DWFG was most commonly due to malignancy (20.0%), infection (19.7%), cardiac disease (12.6%) with risk factors of older age and pretransplant dialysis, and diabetes as the cause of renal failure. For GF, alloimmunity (38.7%), glomerular diseases (18.6%), and tubular injury (13.9%) were the major causes. Competing risk incidence models identified diabetes and older recipients with higher rates of both DWFG and nonalloimmune GF. Conclusions. These data suggest that at baseline, 2 distinct populations can be identified who are at high risk for renal allograft loss: a younger, nondiabetic patient group who develops GF due to alloimmunity and an older, more commonly diabetic population who develops DWFG and GF due to a mixture of causes—many nonalloimmune. Individualized management is needed to improve long-term renal allograft survival in the latter group.

Published in Transplantation Direct

ISSN: 2373-8731 (Online)
Publisher: Wolters Kluwer
Country of publisher: United States
LCC subjects: Medicine: Surgery
Website: http://journals.lww.com/transplantationdirect/Pages/default.aspx

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