September 23, 2019
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Risk factors for graft loss 1-year after kidney transplant identified

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Researchers have identified six factors associated with graft loss 1 year after kidney transplantation.

“After transplantation, maximizing graft longevity becomes a focus of care,” Farid Foroutan, of the Ted Rogers Centre for Heart Research, Multi-organ Transplant Program, at Toronto General Hospital, and colleagues wrote. “Graft loss results in return to dialysis, retransplantation, or death. With the expansion of the pool of kidney grafts, through the use of higher risk donors, and increased attention to donor management strategies, 1-year graft survival may change. It is therefore useful to identify low-risk and high-risk kidney transplant cases.”

Researchers conducted a meta-analysis of 35 studies focusing on 20 risk factors. Considered factors included donor-and-recipient characteristics, as well as transplant process variables and post-transplant complications.

They found six factors that were associated with graft loss with moderate to high degrees of certainty, including donor age (HR =1.11 per 10-year increase), extended criteria donors (HR = 1.35), deceased donors (HR = 1.54), number of HLA mismatches (HR = 1.08 per one mismatch increase), recipient age (HR = 1.17 per 10-year increase) and delayed graft function (HR = 1.89).

Additionally, researchers identified five variables that were, with moderate certainty, associated with 1-year graft loss (donor sex, donor BMI, recipient’s number of years on dialysis, history of smoking and coronary artery disease).

No associations were found between 1-year graft loss and increasing cold ischemia time, recipient age, recipient BMI, recipient diabetes or recipient hypertension. Researchers noted that they were most surprised to find no evidence of an association between donor creatinine and 1-year graft loss.

“From this review, it is evident that numerous recipient and donor characteristics increase the risk of graft loss post-kidney transplantation,” they wrote. “All such factors, although may be associated with graft loss beyond chance, may not be clinically important to diminish the magnitude of benet attained from transplantation. This necessitates the need for risk prediction models to guide clinicians in selection of candidates whose risk for graft loss (disadvantaging the societal need for organ donors) may be higher than their risk of mortality on dialysis. Risk associations generated from this review may inspire or provide the foundational information necessary for development of a risk prediction model.” – by Melissa J. Webb

Disclosures: Foroutan reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

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