Modeling of covariates predicting renal allograft failure within six months after transplantation

Main Article Content

Ubiracé Fernando Elihimas Júnior
Manoel Pereira Guimarães
Orlando Vieira Gomes
Wallace Pereira
Eduardo Eriko Tenório de França
Ulisses Ramos Montarroyos
Emilly Pereira Alves
Frederico Castelo Branco Cavalcanti
Paulo Adriano Schwingel


Introduction: Kidney transplantation (KT) is the renal replacement therapy (RRT) of choice for patients with chronic kidney disease (CKD). However, not every KT is successful and some patients persist on RRT. Objective: To model a logistic regression with pre- and post-KT risk covariates capable of predicting secondary allograft dysfunction in need of RRT or reaching stage V of CKD until the first six months post-KT. Methods: Cohort with KT recipients from Northeastern Brazil. Medical records of KT performed between 2011-2018 were analyzed. KT-recipients with insufficient data or who abandoned follow-up were excluded. The covariables analyzed were: demographic; infectious; pre- and post-KT comorbidities; panel reactive-antibodies; number of HLA mismatches; acute rejection episodes mediated by T-cell (ACR) or antibodies (AAR) six months after KT; and laboratory tests six months after KT. Results: Covariates with higher risk for the analyzed outcomes six months after KT were: elderly KT recipients (OR:1.41; CI95%:1.01-1.99), time between onset of RRT and KT (∆T-RRT&KT)>10years (OR:3.54; CI95%:1.27-9.87), diabetes mellitus (DM) pre-KT (OR:3.35; CI95%:1.51-7.46), pyelonephritis (OR:2.45; CI95%:1.24-4.84), polyomavirus nephropathy (OR:4.99; CI95%:1.87-13.3), AAS (OR:4.82; CI95%:1.35-17.2), 24h-proteinuria ≥300mg/24h (OR:5.05; CI95%:2.00-12.7) and serum calcium (Ca) <8.5mg/dL (OR:4.72; CI95%:2.00-11.1). The multivariate model presented an accuracy of 88.1% and the mean variance inflation factor is 1.81. Conclusion: Elderly-recipients, ∆T-RRT&KT>10 years, pre-KT DM, and post-KT aggressions until six months (pyelonephritis, polyomavirus nephropathy, ABMR, 24h-proteinuria≥300mg/24h, and Ca<8.5mg/dL) are associated with high predictive power for secondary allograft dysfunction in need of RRT or reaching CKD stage V until the first six months post-KT.


Download data is not yet available.

Article Details

How to Cite
Elihimas Júnior, U. F., Guimarães, M. P., Gomes, O. V., Pereira, W., França, E. E. T. de, Montarroyos, U. R., Alves, E. P., Cavalcanti, F. C. B., & Schwingel, P. A. (2022). Modeling of covariates predicting renal allograft failure within six months after transplantation: . ABCS Health Sciences, 47, e022204.
Original Articles


1. Bastos MG, Bregman R, Kirsztajn GM. Doença renal crônica: frequente e grave, mas também prevenível e tratável. Rev Assoc Med Bras. 2010;56(2):248-53.

2. Gouveia DSS, Bignelli AT, Hokazono SR, Danucalov I, Siemens TA, Meyer F, et al. Analysis of economic impact among modalities of renal replacement therapy. J Bras Nefrol. 2017;39(2):162-71.

3. Thomé FS, Sesso RC, Lopes AA, Lugon JR, Martins CT. Brazilian chronic dialysis survey 2017. J Bras Nefrol. 2019;41(2):208-14.

4. Pestana JM. Clinical outcomes of 11.436 kidney transplants performed in a single center - Hospital do Rim. J Bras Nefrol. 2017;39(3):287-95.

5. Kidney Disease: Improving Global Outcomes (KDIGO) Transplant Work Group. KDIGO clinical practice guideline for the care of kidney transplant recipients. Am J Transplant. 2009;9(Suppl 3):S1-155.

6. Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF 3rd, Feldman HI, et al. A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009;150(9):604-12.

7. Foster K, Cohen DJ, D’Agati VD, Markowitz GS. Primary renal allograft dysfunction. Am J Kidney Dis. 2004;44(2):376-81.

8. Orlandi PF, Cristelli MP, Aldworth CAR, Freitas TVS, Felipe CR, Silva Junior HT, et al. Long-term outcomes of elderly kidney transplant recipients. J Bras Nefrol. 2015;37(2):212-20.

9. Haas M, Loupy A, Lefaucheur C, Roufosse C, Glotz D, Seron D, et al. The Banff 2017 Kidney Meeting Report: revised diagnostic criteria for chronic active T cell–mediated rejection, antibody‐mediated rejection, and prospects for integrative endpoints for next‐generation clinical trials. Am J Transplant. 2018;18(2):293-307.

10. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2014;37(Suppl 1):S81-90.

11. Mota LS, Oliveira CMC, Pinheiro FML, Santos LCO, Nóbrega DG, Fernandes PF, et al. Comparative study between kidney transplantation with deceased donor expanded criteria and donor standard criteria in a single center in Brazil. J Bras Nefrol. 2016;38(3):334-43.

12. Armitage P, Berry G, Mathews JNS. Statistical methods in medical research. 4th ed. Oxford: Wiley-Blackwell, 2001.

13. Oniscu GC, Brown H, Forsythe JL. How old is old for transplantation? Am J Transplant. 2004;4(12):2067-74.

14. Gill J, Dong J, Rose C, Gill JS. The risk of allograft failure and the survival benefit of kidney transplantation are complicated by delayed graft function. Kidney Int. 2016;89(6):1331-6.

15. Moreso F, Ortega F, Mendiluce A. Recipient age as a determinant factor of patient and graft survival. Nephrol Dial Transplant. 2004;19(Suppl 3):16-20.

16. Keith DS, Cantarovich M, Paraskevas S, Tchervenkov J. Duration of dialysis pretransplantation is an important risk factor for delayed recovery of renal function following deceased donor kidney transplantation. Transpl Int. 2008;21(2):126-32.

17. Freitas MHB, Lima LC, Couceiro TCM, Silva WB, Andrade JM, Freitas MHB. Perioperative factors associated with delayed graft function in renal transplant patients. J Bras Nefrol. 2018;40(4):360-5.

18. Ruppel P, Felipe CR, Medina-Pestana JO, Hiramoto LL, Viana L, Ferreira A, et al. The influence of clinical, environmental, and socioeconomic factors on five-year patient survival after kidney transplantation. J Bras Nefrol. 2018;40(2):151-61.

19. Silva SB, Caulliraux HM, Araújo CAS, Rocha E. Uma comparação dos custos do transplante renal em relação às diálises no Brasil. Cad Saude Publica. 2016;32(6):e00013515.

20. Tavares MG, Tedesco-Silva Junior H, Pestana JOM. Early Hospital Readmission (EHR) in kidney transplantation: a review article. Bras J Nephrol. 2020;42(2):231-7.

21. Kim WR, Lake JR, Smith JM, Skeans MA, Schladt DP, Edwards EB, et al. OPTN/SRTR 2013 Annual Data Report: liver. Am J Transplant. 2015;15(Suppl 2):1-28.

22. Al Midani A, Elands S, Collier S, Harber M, Shendi AM. Impact of Urinary Tract Infections in Kidney Transplant Recipients: A 4-Year Single-Center Experience. Transplant Proc. 2018;50(10):3351-5.

23. Sousa SR, Galante NZ, Barbosa DA, Pestana JOM. Incidência e fatores de risco para complicações infecciosas no primeiro ano após o transplante renal. J Bras Nefrol. 2010;32(1):77- 84.

24. Pesce F, Martino M, Fiorentino M, Rollo T, Simone S, Gallo P, et al. Recurrent urinary tract infections in kidney transplant recipients during the first-year influence long-term graft function: a single-center retrospective cohort study. J Nephrol. 2019;32(4):661-8.

25. Godoy-Carrillo MC, Meneses-Saco A, Torrealva CV, Pastor AC. Nefropatía por poliomavirus en un paciente inmunosuprimido por trasplante renal secundario a la enfermedad de arteritis de Takayasu. Infectio. 2016;20(4):286-8.

26. Pinto GG, Poloni JAT, Rotta LN, Razonable RR, Pasqualotto AC. Screening for BK virus nephropathy in kidney transplant recipients: comparison of diagnostic tests. J Bras Nefrol. 2016;38(3):356-62.

27. Berger SP, Sommerer C, Witzke O, Tedesco H, Chadban S, Mulgaonkar S, et al. Two-year outcomes in de novo renal transplant recipients receiving everolimus-facilitated calcineurin inhibitor reduction regimen from the TRANSFORM study. Am J Transplant. 2019;19(11):3018-34.

28. Maciel MMD, Ceccato MG, Carvalho WS, Navarro PD, Farah KP, Miranda SS. Prevalence of latent Mycobacterium tuberculosis infection in renal transplant recipients. J Bras Pneumol. 2018;44(6):461-8.

29. Machado FP, Vicari AR, Spuldaro F, Castro JBS de, Manfro RC. Polyclonal anti T-lymphocyte antibody therapy monitoring in kidney transplant recipients: comparison of CD3+ T cell and total lymphocyte counts. Einstein (São Paulo). 2018;16(4):eAO4278.

30. Gomes LK, Custódio MR, Contieri FLC, Riella MC, Nascimento MM do. Persistent disorders of mineral metabolism after one year of kidney transplantation. J Bras Nefrol. 2016;38(3):282-7.

31. Gueiros APS, Neves CL, Sampaio EA, Custódio MR, Sociedade Brasileira de Nefrologia. Distúrbio mineral e ósseo após o transplante renal. J Bras Nefrol. 2011;33(2):227-31.

32. Castro MCM. Conservative management for patients with chronic kidney disease refusing dialysis. J Bras Nefrol. 2019;41(1):95-102.

33. Okada M, Hiramitsu T, Ichimori T, Goto N, Narumi S, Watarai Y, et al. Comparison of pre- and post-transplant parathyroidectomy in renal transplant recipients and the impact of parathyroidectomy timing on calcium metabolism and renal allograft function: a retrospective single-center analysis. World J Surg. 2020;44(2):498-507.

34. Sancho A, Gavela E, Morales A, Crespo JF, Pallardo LM. Risk factors and prognosis for proteinuria in renal transplant recipients. Transplant Proc. 2007;39(7):2145-7.

35. Oliveira CMC, Pereira IS, Souza LCL, Cruz TA, Pinheiro Júnior FML, Esmeraldo RM. Proteinúria after kidney transplantation - prevalence and risk factors. J Bras Nefrol. 2015;37(4):481-9.

36. Thomas B, Taber DJ, Srinivas TR. Hypertension after kidney transplantation: a pathophysiologic approach. Curr Hypertens Rep. 2013;15(5):458-69.

37. Andrade LGM, Tedesco-Silva H. Recycling of predictors used to estimate glomerular filtration rate: insight into lateral collinearity. PLoS One. 2020;15(2):e0228842.