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Bruce Kaplan

Publications and source records attributed to Bruce Kaplan.

At least 55 records · Page 3Linked to original sources
PubMed2003

Overview of large database analysis in renal transplantation.

The discipline of renal transplantation has been fortunate in having one of the largest and most complete databases of any field of medical inquiry. Many analyses have been performed utilizing these databases and a wide array of views regarding the role and limitations of these analyses exists. In this manuscript, we hope to present the merits and limitations of large database analysis in renal transplantation. In addition, we will attempt to go over the major databases' structures and the critical issues of coding, verification and clinical awareness that help maintain the integrity of this type of analysis. Other fundamental issues that will be covered include the relationship of single center and randomized prospective studies with database analyses, statistical considerations, and hidden selection bias inherent in registry analysis. We hope to present both a guide to investigators who are first embarking on large-scale database analysis and also to present a fair view of the utility and limitations of a potentially very useful research tool in renal transplantation.

Databases, Factual↗
PubMed2003

Renal allograft survival in transplant recipients with focal segmental glomerulosclerosis.

Previous literature suggests that the recurrence of focal segmental glomerulosclerosis (FSGS) after renal transplantation is more common in recipients who have received an HLA-identical living-related (LRD) transplant. To address the question if FSGS patients can safely receive a 6-antigen match LRD kidney transplant, we analyzed death-censored renal allograft survival data of FSGS patients from the United States Renal Data System database (USRDS). Using the USRDS and the U.S. Scientific Renal Transplant Registry between the years 1988-97, we found 19259 adult primary renal transplant recipients, of which 2414 patients had FSGS as their primary diagnosis as compared to 16845 patients who had other types of glomerulonephritis (GN). A Cox proportional hazard model was used to estimate death-censored graft survival among FSGS patients with a zero mismatch LRD kidney transplant. The model included a triple interaction term comparing FSGS vs. GN vs. living donation (LD) vs. cadaveric donation (CAD) vs. zero mismatch (six antigen or HLA-identical) vs. mismatch. Annually adjusted death censored graft loss rates per 1000 patients (ADGL) were calculated. Focal segmental glomerulosclerosis patients receiving a zero mismatch LRD kidney transplant had the lowest ADGL rate, losing 10.5 grafts per 1000 patients per year. Not significantly different but higher (14.3) was the ADGL rate for LD, zero mismatch GN recipients. The ADGL rate was significantly higher in FSGS recipients who received a LD, mismatched transplant (36.5). Focal segmental glomerulosclerosis patients who received a CAD, zero mismatched graft (44.1), or CAD, mismatched graft (63.2), had significantly higher ADGL rates. Zero mismatch LRD kidney transplants are not a risk factor for graft loss in FSGS patients but are associated with significantly better death-censored graft survival as compared to CAD 6-antigen match or mismatched donations.

Glomerulosclerosis, Focal Segmental↗
PubMed2003

Long-term use of mycophenolate mofetil is associated with a reduction in the incidence and risk of late rejection.

To evaluate the association of long-term continuous (minimum 1 year) mycophenolate mofetil (MMF) vs. azathioprine (AZA) therapy with the incidence of late acute rejection, we analyzed 47 693 primary renal allograft recipients reported to the United States Renal Data System between 1988 and 1998. The primary study endpoint was acute rejection beyond 1 year after transplantation. Univariate Kaplan-Meier analysis and multivariate Cox proportional hazard models were used to investigate the risk of reaching the study endpoints. All multivariate analyses were corrected for potential confounding covariates. Mycophenolate mofetil was associated with a 65% decreased risk of developing late acute rejection as compared to AZA (RR = 0.35, CI 0.27-0.45, p < 0.001). The incidence of acute rejection episodes at 2 and 3 years post-transplantation was significantly lower in the MMF group (0.9% at 2 years, 1.1% at 3 years) than the AZA group (6.1% at 2 years, 9.3% at 3 years). In the primary vs. repeat late rejection analysis, MMF patients exhibited a decreased late acute rejection risk of 72% (RR = 0.28, p < 0.001) and 60%, respectively (RR = 0.40, p < 0.001). In African Americans, the late acute rejection risk was 70% lower in MMF patients than AZA patients (RR = 0.30, p < 0.001). Further study is indicated to determine the optimal duration of MMF therapy after renal allograft transplantation.

Black People↗
PubMed2003

Poor predictive value of serum creatinine for renal allograft loss.

Both medical care and pharmaceutical development have led to an increase in expected graft and patient survival for patients who undergo renal transplantation. From a research perspective, it has become increasingly difficult to study the efficacy of new therapies using traditional 'hard' endpoints. In reaction to this dilemma, the transplant community has sought a surrogate endpoint. A natural candidate for a surrogate marker for graft loss that has been proposed is renal function (serum creatinine or calculated GFR levels). Using data from the USRDS, we conducted a retrospective evaluation of transplant data from 1988 to 1999 to quantify the predictive value of renal function for the outcomes of graft loss, death-censored graft loss, and patient death. Renal function along with the change in renal function demonstrated a high relative risk for ultimate graft survival and graft loss (odds ratio = 2.2 for an increase of 1 mg/dL). However, the predictive value as measured by the area under the receiver operating characteristic curve (AUC) for this criteria was poor (0.627). These findings held true for the slope of creatinine and formulations of GFR. While renal function is a strong risk factor and highly correlated with graft failure, the utility of renal function as a predictive tool for graft loss is limited.

Creatinine↗
PubMed2003

Long-term graft survival with neoral and tacrolimus: a paired kidney analysis.

Calcineurin inhibitors (CNI) are an important component of most immunosuppressive protocols utilized in renal transplantation. Both CNI available (cyclosporine and tacrolimus) have been used for many years. Studies comparing the efficacy of these two agents in terms of long-term graft or patient survival have thus far failed to show an advantage for either agent. This failure to show a difference could possibly be due to underpowering of clinical trials. The authors used the SRTR database to analyze 5-yr graft survival of the microemulsion formulation of cyclosporine (Neoral) as compared with tacrolimus. To minimize the donor variability and bias, a paired kidney analysis was used. Deceased donors from the years 1995-2002 were analyzed from the SRTR database. All paired kidneys during this period, where one kidney was allocated to a patient receiving initial Neoral therapy and its mate allocated to a patient receiving initial tacrolimus therapy were evaluated. Multivariate and univariate analysis were performed. Univariate analysis demonstrated equivalent graft survival for Neoral compared with tacrolimus (66.9% versus 65.9%, respectively). Multivariate analysis could not demonstrate a difference in risk for 5-yr patient survival or graft loss. Renal function was superior for tacrolimus at all time points, whereas the slope of 1/Cr over time did not differ for the two agents. In this paired kidney analysis, no difference in 5-yr renal allograft survival could be found between the two agents. Renal function was superior in the patients receiving initial tacrolimus therapy; however, slope of 1/Cr did not differ between the agents.

Adult↗
PubMed2003

Mycophenolate mofetil in solid-organ transplantation.

This review focuses on the use of mycophenolate mofetil (MMF) as an immunosuppressive agent in solid-organ transplantation. MMF, a non-competitive inhibitor of inosine monophosphate dehydrogenase, blocks de novo purine synthesis in T and B lymphocytes, resulting in the selective inhibition of proliferation of these cells in response to antigenic stimuli. MMF may also promote apoptosis of these cells. The immunosuppressive ability of MMF is thought to derive mainly from the inhibition of inosine monophosphate dehydrogenase. The other effects of MMF include suppression of antibody synthesis by B lymphocytes, inhibition of proliferation of smooth muscle cells in culture and impaired glycosylation of adhesion molecules. MMF may exhibit anti-inflammatory effects resulting from decreased activity of the inducible form of nitric oxide synthase, a consequence of depletion of tetrahydrobiopterin, which leads to decreased generation of peroxynitrite, a pro-inflammatory molecule. The pharmacokinetics, pharmacodynamics and principles underlying therapeutic drug monitoring of MMF are reviewed. The results of the pivotal clinical trials of MMF in kidney and heart transplantation are discussed and a summary of the major studies demonstrating a positive effect of MMF on renal transplantation outcomes is presented. The use of MMF in the context of ABO-incompatible renal transplantation, renal transplantation in highly sensitised and cross-match positive recipients, humoral rejection of renal allografts, chronic allograft nephropathy and steroid/calcineurin inhibitor minimisation in renal transplantation are also discussed.

Animals↗
PubMed2002

Renal transplantations performed using non-heart-beating organ donors: going back to the future?

BACKGROUND: As more expanded-criteria organ donors are used to bridge the widening gap between organ supply and demand, non-heart-beating (NHB) donors will become increasingly important. The purpose of this study was to analyze renal transplant outcomes using this source of cadaveric (CAD) organs and compare the results with heart-beating organ sources. METHODS: Data from 98,698 adult CAD renal transplant recipients and 34,531 living donor renal transplant recipients registered in the U. S. Renal Data System database between January 1993 and June 2000 were analyzed. Kaplan-Meier survival curves were used to compare graft and patient survival rates between NHB, CAD, and living donor transplant recipients. Cox proportional hazards models were used to identify risk factors for NHB donor recipients, while adjusting for potential confounding variables. RESULTS: Recipients of NHB donor organs experienced nearly twice the incidence of delayed graft function (DGF) compared with heart-beating donors (42.4% vs. 23.3%, respectively). NHB donor transplants experienced comparable allograft survival when compared with CAD transplants at 6 years (73.2% vs. 72.5%, respectively; P=NS); patient survival was greater at 6 years for NHB compared with CAD renal transplant recipients (80.9% vs. 77.8%, respectively; P=NS). Significant factors for allograft loss for NHB donor organ recipients included the following: organ used for repeat transplants; DGF; donor age older than 35 years; and head trauma as a cause of initial injury (relative risk 2.74, 1.90, 1.78, and 1.41, respectively). CONCLUSIONS: Although exhibiting elevated DGF rates, allograft and patient survival rates of transplants from NHB donor sources are equivalent to those from conventional CAD sources. Donor age, recipient transplant number, female recipient, mechanism of injury, and DGF were the most pertinent variables leading to poor outcomes.

Adult↗
PubMed2002

Waiting time on dialysis as the strongest modifiable risk factor for renal transplant outcomes: a paired donor kidney analysis.

BACKGROUND: Waiting time on dialysis has been shown to be associated with worse outcomes after living and cadaveric transplantation. To validate and quantify end-stage renal disease (ESRD) time as an independent risk factor for kidney transplantation, we compared the outcome of paired donor kidneys, destined to patients who had ESRD more than 2 years compared to patients who had ESRD less than 6 months. METHODS: We analyzed data available from the U.S. Renal Data System database between 1988 and 1998 by Kaplan-Meier estimates and Cox proportional hazards models to quantify the effect of ESRD time on paired cadaveric kidneys and on all cadaveric kidneys compared to living-donated kidneys. RESULTS: Five- and 10-year unadjusted graft survival rates were significantly worse in paired kidney recipients who had undergone more than 24 months of dialysis (58% and 29%, respectively) compared to paired kidney recipients who had undergone less than 6 months of dialysis (78% and 63%, respectively; P<0.001 each). Ten-year overall adjusted graft survival for cadaveric transplants was 69% for preemptive transplants versus 39% for transplants after 24 months on dialysis. For living transplants, 10-year overall adjusted graft survival was 75% for preemptive transplants versus 49% for transplants after 24 month on dialysis. CONCLUSIONS: ESRD time is arguably the strongest independent modifiable risk factor for renal transplant outcomes. Part of the advantage of living-donor versus cadaveric-donor transplantation may be explained by waiting time. This effect is dominant enough that a cadaveric renal transplant recipient with an ESRD time less than 6 months has the equivalent graft survival of living donor transplant recipients who wait on dialysis for more than 2 years.

Adult↗
PubMed2002

Renal allograft survival in patients with oxalosis.

BACKGROUND: Primary hyperoxaluria is a rare autosomal recessive metabolic disease that often progresses to end-stage renal disease (ESRD). Liver transplantation is curative for patients with the alanine: glyoxylate aminotransferase deficiency. For oxalosis patients with minor enzyme deficiencies, renal transplantation may be the therapy of choice although concern exists about recurrence of oxalosis in the transplanted kidney. To date, previous data has been conflicting with most reports indicating poor renal allograft survival for oxalosis patients who receive a renal transplant alone. To determine whether graft survival in renal transplant recipients with oxalosis is similar to other transplant recipients with other forms of ESRD, we analyzed the United States Renal Data System (USRDS) registry comparing death-censored graft survival for transplant recipients with oxalosis to a reference group with ESRD secondary to glomerulonephritis (GN). METHODS: Using the USRDS and the U.S. Scientific Renal Transplant Registry data, we found 190 adult renal transplant recipients from 1988 to 1998 who had oxalosis as their primary diagnosis for their ESRD. Among the patients with oxalosis, 56 patients had a liver transplant followed by a kidney transplant (LKTx) and 134 patients had a kidney transplant alone (KTA). A Cox proportional hazard model was used to estimate patient survival and death-censored graft survival for patients with oxalosis who received a LKTx or a KTA. Unadjusted death-censored graft survival for oxalosis patients with a cadaveric or living-donor KTA or with a LKTx was obtained from Kaplan-Meier analysis. Recipients of solitary kidney transplants with GN served as the reference group. RESULTS: Oxalosis patients receiving a KTA had a significantly worse adjusted death-censored graft survival (47.9%) compared with patients with GN (61%) at 8 years posttransplantation (P <0.001). In contrast, oxalosis patients who received a LKTx had a significantly higher death-censored graft survival (76%) compared with oxalosis patients who received a KTA (47.9%, P<0.001) and had a trend toward better death-censored graft survival compared with patients with GN (P =0.05). In addition, oxalosis patients who received a living-donor KTA had significantly worse death-censored graft survival compared with oxalosis patients who received a LKTx (22% vs. 64%, P<0.01). Patient survival for oxalosis recipients with a KTA or a LKTx was not significantly different. CONCLUSIONS: Patients with oxalosis who receive a LKTx have superior death-censored graft survival compared with oxalosis patients who receive a cadaveric or living-donor KTA and trended toward better graft survival compared with GN patients.

Adult↗
PubMed2002

Exposure-response relationships for everolimus in de novo kidney transplantation: defining a therapeutic range.

BACKGROUND: Exposure, safety, and efficacy data from the two everolimus randomized, double-blind phase 3 trials were evaluated to identify a therapeutic concentration range applicable in de novo kidney transplantation. METHODS: A total of 695 evaluable everolimus-treated patients received either 0.75 or 1.5 mg bid in addition to corticosteroids and cyclosporine (troughs 150-400 ng/ml in month 1 and 100-300 ng/ml thereafter). A total of 3355 everolimus trough levels (Cmin) were obtained in weeks 1 and 2 and months 1, 2, 3, and 6 after transplantation. Each patient's average Cmin was calculated and the values were divided into quintiles: 1.0-3.4, 3.5-4.5, 4.6-5.7, 5.8-7.7, 7.8-15.0 ng/ml (139 patients per quintile). Efficacy was freedom from biopsy-confirmed acute rejection. Safety measures were maximum total cholesterol and triglyceride levels and minimum leukocyte and platelet counts. A sigmoid exposure-response model was used to test the significance of these Cmin-efficacy and Cmin-safety relationships. RESULTS: Freedom from acute rejection was significantly related to Cmin with an incidence of 68% at 1.0-3.4 ng/ml, 81-86% at 3.5-7.7 ng/ml, and 91% at 7.8-15.0 ng/ml (P=0.03). The incidence of hypercholesterolemia, defined as >6.5 mmol/liter, ranged from 76 to 87% over the exposure range without a significant relation to Cmin (P=0.37). The incidence of hypertriglyceridemia, defined as >2.9 mmol/liter, rose from 59 to 77% across the exposure groups (P=0.02). Leukocytopenia, defined as <4x10(9)/liter, occurred in 11-19% of patients across the exposure quintiles showing no relationship to Cmin (P=0.76). The incidence of thrombocytopenia, defined as <100x10(9)/liter, occurred in </=10% of patients in the first 3 Cmin quintiles and was 14 and 17% in Cmin quintiles 4 and 5 (P=0.21). CONCLUSIONS: A significantly increased risk of acute rejection was observed at everolimus trough levels <3 ng/ml. This is a lower therapeutic concentration limit when everolimus is used with conventionally dosed cyclosporine. Because hyperlipidemias responded to counter-measure therapies and thrombocytopenia had an overall low incidence of 12%, everolimus-related adverse events were manageable up to the highest troughs observed in this population of 15 ng/ml. An upper therapeutic concentration limit is likely more than 15 ng/ml but a precise value could not be derived from these data.

Adrenal Cortex Hormones↗
PubMed2002

The impact of body mass index on renal transplant outcomes: a significant independent risk factor for graft failure and patient death.

INTRODUCTION: Renal transplant recipients with elevated body mass index (BMI) have been shown to have inferior patient survival as compared to patients with lower BMI. However, previous studies could not establish a link between increased BMI and decreased death censored graft survival. Obesity in nontransplant patients has been associated with hypertension, hyperlipidemia, type II diabetes, proteinuria and glomerulopathy. Given this evidence it is possible that renal transplant recipients with an elevated BMI may have worse long term graft survival. To investigate this hypothesis we retrospectively analyzed 51,927 primary, adult renal transplants registered in the USRDS. METHODS: BMI at date of transplant was calculated for all patients using BMI=body weight (in kg)=.stature (height, in meters) squared. BMI values were further categorized into 11 categories: below 18, from 18 to 36 at 2 unit increments, and above 36 kg/m2. Primary study end points were graft and patient survival. Secondary study end points were death censored graft survival, chronic allograft failure, delayed graft function, and acute rejection (AR). Cox proportional hazard and logistic regression models investigated the link between categorized BMI and the study end points correcting for potential confounding variables. RESULTS: BMI showed a very strong association with outcomes after renal transplantation. The extremes of very high and very low BMI were associated with significantly worse patient and graft survival. The same was true for death censored graft survival and chronic allograft failure. Elevated BMI was also associated with an increased risk for delayed graft function while lower BMI was significantly protective. Acute rejection did not show any significant association with BMI. CONCLUSIONS: BMI has a very strong association with outcomes after renal transplantation independent of most of the known risk factors for patient and graft survival. The extremes of very high and very low BMI before renal transplantation are important risk factors for patient and graft survival. It is important to note that elevated BMI was significantly associated with worse graft survival independent of patient survival. Whether prospective weight adjustment before renal transplantation can favorably affect posttransplant risk needs to be assessed by further studies.

Adult↗
PubMed2002

Cyclosporine microemulsion and tacrolimus are associated with decreased chronic allograft failure and improved long-term graft survival as compared with sandimmune.

Tacrolimus and cyclosporine in the microemulsion formulation Neoral have demonstrated improvements in acute rejection rates after renal transplantation compared with conventional cyclosporine formulation, Sandimmune. To evaluate whether these drugs are also associated with improvements in chronic allograft failure (CAF) rates, we retrospectively analyzed 32,040 primary renal allograft recipients reported to the United States Renal Data System (USRDS) between 1994 and 1997. Graft loss secondary to CAF was defined as graft loss beyond 6 months post-transplant, censored for death, acute rejection, thrombosis, infections and noncompliance. A Cox proportional hazard model was used to investigate the relationship between graft loss secondary to CAF and the use of conventional cyclosporine formulation, as opposed to cyclosporine microemulsion and tacrolimus (Prograf). The analysis was corrected for confounding variables, such as acute rejection, sex, race, human leukocyte antigen (HLA) mismatch, % panel reactive antibodies (PRA), delayed graft function (DGF), cold ischemia time, induction therapy, dialysis time, etiology of end-stage renal disease, cytomegalovirus (CMV) risk group, donor source, era effect, and mycophenolate mofetil (MMF) use. Cyclosporine microemulsion use was associated with a significantly lower relative risk (RR = 0.6, Cl = 0.5-0.7) for CAF as opposed to conventional cyclosporine formulation. Likewise tacrolimus as compared with conventional cyclosporine formulation was associated with a significantly lower relative risk (RR = 0.7, CI = 0.6-0.8) for CAF. Conventional cyclosporine formulation treatment was associated with a 87.6% adjusted CAF-free survival rate at 4 years. Both tacrolimus and cyclosporine microemulsion were associated with a significantly better adjusted CAF-free survival at 4years (91.4 and 92.4%, respectively). Both cyclosporine microemulsion and tacrolimus are associated with improved graft survival and a decreased relative risk for CAF when compared with the older conventional cyclosporine formulation. This association is independent of the use of MMF or changes in era.

Adult↗
PubMed2002

Death after graft loss: an important late study endpoint in kidney transplantation.

Traditional study endpoints utilized in renal transplantation have included graft survival, and death with a functioning graft. We analyzed the risk factors for death after allograft loss (DAGL) among a total of 78564 primary renal transplants reported to the United States Renal Data System (USRDS) from 1988 to 1998. Cox models were used to investigate risk factors for DAGL. Of 15528 deaths, 10816 occurred before, and 4712 occurred after graft loss. Overall annual adjusted death rates were more than 3-fold higher after graft loss as compared to before graft loss (9.42% vs. 2.81%). By Cox model, dialysis for more than 2 years was associated with a more than 2-fold relative risk for DAGL (RR = 2.2, Cl = 1.88-2.53), while transplant time was not associated with DAGL. Infection related graft losses showed a strong association with DAGL (RR = 1.64, Cl = 1.31-2.07). Acute rejection and thrombosis as causes of graft loss were also significantly associated with the risk for DAGL (RR = 1.35, Cl = 1.23-1.47 and RR = 1.39, Cl = 1.39). Patient survival after graft loss is poor. The lack of association between DAGL and transplant time, as opposed to the strong relation to pretransplant dialysis time, would suggest the adverse effects of previous uremia-mediated damage may be contributing to this phenomenon, along with the adverse effects of loss of renal function.

Cause of Death↗
PubMed2002

Interaction between donor and recipient age in determining the risk of chronic renal allograft failure.

OBJECTIVES: Donor age is a known risk factor for chronic allograft failure (CAF) in renal transplant recipients. We have recently shown that advanced recipient age is also a risk factor for CAF. To investigate the interaction between donor and recipient age, we analyzed 40,289 primary solitary Caucasian adult renal transplants registered at the United States Renal Data System (USRDS) from 1988 to 1997. DESIGN: CAF was defined as allograft loss beyond 6 months posttransplantation, censored for death, recurrent disease, acute rejection, thrombosis, noncompliance, infection, or technical problems. Cox proportional hazards models were used to investigate the risk of allograft loss secondary to CAF. All models were corrected for 15 covariates including donor and recipient demographics, ischemic time, and human leukocyte antigen match. Donor and recipient age were categorized, and relative risk for allograft loss of the interaction between the obtained categorical covariates was evaluated. SETTING: Retrospective data analysis using the USRDS. PARTICIPANTS: All primary Caucasian renal transplant recipients from 1988 to 1997. RESULTS: Patients aged 55 and older who received donor kidneys had a 110% increased risk of CAF (relative risk (RR) = 2.1, 95% confidence interval (CI) = 1.9-2.3, P< .001) and recipients aged 65 and older had a 90% increased risk for CAF (RR = 1.9, 95% CI = 1.61-2.1, P< .001), compared with the youngest reference groups. In addition, there was an additive and, in the long term, synergistic interaction between donor and recipient age in determining allograft loss. CONCLUSIONS: Donor and recipient age had an independent, equivalently detrimental effect on renal allograft survival. An overall additive and, in the long term (beyond 36 months posttransplant), synergistic deleterious effect on renal allograft survival was observed for the interaction of donor and recipient age.

Adult↗
PubMed2002

Factors associated with long-term renal allograft survival.

Major advances in immunosuppression and reductions in the rates of acute rejection have led to increasing graft and patient survival rates during the past two decades. Chronic dysfunction of the renal allograft, however, remains a major clinical problem and probably represents the end result of the complex interplay between donor and recipient factors, immunologic injury, nonimmunologic insults, and drug-induced nephrotoxicity. Optimal function of the renal allograft is obtained by maintaining a balance between underimmunosuppression and acute rejection and overimmunosuppression and drug-induced toxicities. To minimize side effects while maintaining efficacy, immunosuppressive drugs are commonly used as combination therapy. Pharmacokinetic and pharmacodynamic interactions between these agents can affect graft survival and function. The evidence supporting the role of therapeutic drug monitoring as applied to commonly used immunosuppressants in modern transplantation is presented here, and the increasing role of therapeutic drug monitoring in the optimization of graft and patient survival rates in the modern era of renal transplantation is discussed.

Drug Monitoring↗
PubMed2002

Association of antibody induction with short- and long-term cause-specific mortality in renal transplant recipients.

A total of 73,707 primary renal transplants reported to the USRDS between 1988 and 1997 were examined to investigate the cause-specific risk for patient death associated with anti-lymphocyte antibody induction therapy (ABI). Cox proportional hazard models were used to estimate the relative risk of the use of ABI and patient death. All Cox models were corrected for potential confounding variables, such as age, gender, race, HLA mismatch, panel reactive antibody, delayed graft function, cold ischemia time, time since start of dialysis, etiology of end-stage renal disease, cytomegalovirus risk group, donor source (living or cadaveric), era effect, and immunosuppressive therapy. Primary study end points were patient death with functioning graft (DWFG) and overall patient death, including death after graft loss. Early patient death (deaths within the first 6 mo after renal transplantation) and late death (deaths after 6 mo post-renal transplantation) were investigated separately. Additionally, specific causes of death were investigated. ABI was associated with a significant risk for late death after renal transplantation (relative risk [RR] = 1.1; P < 0.001) but not for DWFG (RR = 0.94; P = 0.10). ABI conferred the highest RR for late malignancy-related death (RR = 1.35; P < 0.001). ABI was significantly associated with early deaths due to infection and cardiovascular causes (RR = 1.32 [P < 0.001] and RR = 1.27 [P < 0.001], respectively). Kaplan Meier plots confirmed that the risk of ABI for patient death secondary to infectious complications was increased predominately early after transplantation as opposed to late for malignancy-related death. ABI was associated with a significant relative risk for patient death secondary to cardiovascular causes and infectious complications early in the posttransplant period. In addition, ABI was associated with a significant risk for long-term malignancy-related death. The risk of ABI should be taken in context with potential benefits of this therapy.

Adult↗
PubMed2002

Mortality risk assessment after renal transplantation.

Mortality after renal allograft loss is significantly increased as compared to patients with a well-functioning graft. This further emphasizes the beneficial effects of renal transplantation in prolonging life in patients with end-stage renal disease. Factors that impact DWFG also are associated with the risk of cause-specific mortality after graft loss. Factors that were associated with an increased risk of DAGL included prolonged waiting time on dialysis, poor renal function at one year, diabetes mellitus and acute rejection, but not longer time with a functioning transplant. It is possible that by modifying some of these variables, overall mortality might be influenced in a positive way. Just as important, the increased mortality after graft loss further emphasizes the importance of maintaining a well-functioning renal allograft.

Cause of Death↗