1. Change in Estimated GFR and Risk of Allograft Failure in Patients Diagnosed With Late Active Antibody-mediated Rejection Following Kidney Transplantation.
- Author
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Irish W, Nickerson P, Astor BC, Chong E, Wiebe C, Moreso F, Seron D, Crespo M, Gache L, and Djamali A
- Subjects
- Acute Disease, Adult, Allografts, Biopsy, Female, Follow-Up Studies, Graft Rejection physiopathology, Humans, Kidney pathology, Male, Retrospective Studies, Time Factors, Glomerular Filtration Rate physiology, Graft Rejection diagnosis, Graft Survival, Kidney physiopathology, Kidney Transplantation adverse effects
- Abstract
Background: There are challenges in designing adequate, well-controlled studies of patients with active antibody-mediated rejection (AMR) after kidney transplantation (KTx)., Methods: We assessed the functional relationship between change in estimated glomerular filtration rate (eGFR) following the diagnosis of AMR and the risk of subsequent death-censored graft failure using the joint modeling framework. We included recipients of solitary KTx between 1995 and 2013 at 4 transplant centers diagnosed with biopsy-proven active AMR at least 1 year post-KTx, who had a minimum of 3-year follow-up., Results: A total of 91 patients across participating centers were included in the analysis. Of the 91 patients, n = 54 patients (59%) met the death-censored graft failure endpoint and n = 62 patients (68%) met the all-cause graft failure composite endpoint. Kaplan-Meier death-censored graft survival rates at 12, 36, and 60 months postdiagnosis of AMR pooled across centers were 88.9%, 58.9%, and 36.4%, respectively. Spaghetti plots indicated a linear trend in the change in eGFR, especially in the first 12 months postdiagnosis of active AMR. A significant change in eGFR was observed within the first 12 months postdiagnosis of active AMR, getting worse by a factor of -0.757 mL/min/1.73 m2 per month during the 12-month analysis period (a delta of -9.084 mL/min/1.73 m2 at 1 y). Notably, an extrapolated 30% improvement in the slope of eGFR in the first 12 months was associated with a 10% improvement in death-censored graft failure at 5 years., Conclusions: If prospectively validated, this study may inform the design of pivotal clinical trials for therapies for late AMR., Competing Interests: E.C. is an employee of Vitaeris, Inc (Vancouver, BC) that funded the project. L.G. is an employee of CTI Clinical Trial and Consulting Services (Covington, KY), a contract research organization. The other authors declare no conflicts of interest., (Copyright © 2020 The Author(s). Published by Wolters Kluwer Health, Inc.)
- Published
- 2021
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