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

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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

Abstract

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.

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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. https://doi.org/10.7322/abcshs.2020112.1566
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Original Articles

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