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The effect of delayed graft function on graft and patient survival in kidney transplantation: an approach using competing events analysis
- Source :
- Repositório Científico de Acesso Aberto de Portugal, Repositório Científico de Acesso Aberto de Portugal (RCAAP), instacron:RCAAP
- Publication Year :
- 2015
- Publisher :
- Frontiers Media SA, 2015.
-
Abstract
- Objective In kidney transplantation, the impact of delayed graft function (DGF) on long-term graft and patient survival is controversial. We examined the impact of DGF on graft and recipient survival by accounting for the possibility that death with graft function may act as a competing risk for allograft failure. Study design and Setting We used data from 1281 adult primary deceased-donor kidney recipients whose allografts functioned at least 1 year. Results The probability of graft loss occurrence is overestimated using the complement of Kaplan–Meier estimates (1-KM). Both the cause-specific Cox proportional hazard regression model (standard Cox) and the subdistribution hazard regression model proposed by Fine and Gray showed that DGF was associated with shorter time to graft failure (csHR = 2.0, P = 0.002; sHR = 1.57, P = 0.009), independent of acute rejection (AR) and after adjusting for traditional factors associated with graft failure. Regarding patient survival, DGF was a predictor of patient death using the cause-specific Cox model (csHR = 1.57, P = 0.029) but not using the subdistribution model. Conclusions The probability of graft loss from competing end points should not be reported with the 1-KM. Application of a regression model for subdistribution hazard showed that, independent of AR, DGF has a detrimental effect on long-term graft survival, but not on patient survival.
- Subjects :
- Adult
Graft Rejection
Male
medicine.medical_specialty
Graft failure
Allograft failure
Delayed Graft Function
Kaplan-Meier Estimate
Graft function
Kidney transplantation
Risk Factors
Internal medicine
medicine
Humans
Proportional Hazards Models
Retrospective Studies
Transplantation
Proportional hazards model
business.industry
Incidence
Graft Survival
Patient survival
Regression analysis
Delayed graft function
Middle Aged
medicine.disease
Kidney Transplantation
Tissue Donors
Surgery
Treatment Outcome
surgical procedures, operative
Cardiology
Regression Analysis
Female
business
Algorithms
Follow-Up Studies
Subjects
Details
- Language :
- English
- ISSN :
- 09340874
- Volume :
- 28
- Database :
- OpenAIRE
- Journal :
- Transplant International
- Accession number :
- edsair.doi.dedup.....7ef54971384899d07c2b38c333b30f0c
- Full Text :
- https://doi.org/10.1111/tri.12543