Estimated One-Year Glomerular Filtration Rate is the Best Predictor of Long-term Graft Function Following Renal Transplant

Salvadori, Maurizio; Rosati, Alberto; Böck, Andreas; Chapman, Jeremy R.; Dussol, Bertrand; Fritsche, Lutz; Kliem, Volker; Lebranchu, Yvon; Oppenheimer, Federico; Pohanka, E; Tufveson, Gunnar; Bertoni, E.

doi:10.1097/01.tp.0000188135.04259.2e

Cited by 100 publications

(97 citation statements)

References 21 publications

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“…In spite of the detrimental effect of renal dysfunction in slope analysis, eGFR at first observation correlated significantly with that at last observation, confirming the notion [24,25] that early kidney function is a useful surrogate marker for graft outcome.…”

Section: Discussionsupporting

confidence: 70%

Measurement Error in Estimated GFR Slopes across Transplant Chronic Kidney Disease Stages

Hossain¹,

Attia²,

Shoker³

2009

Am J Nephrol

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Background: This study examines if transplant glomerular filtration rate (GFR) slope prediction is affected by the degree of transplant chronic kidney disease (CKDT) stage. Methods: Serial changes in estimated GFR (ΔeGFR) by Cockcroft-Gault (CG) and Modified Diet in Renal Disease-Isotope Dilution Mass Spectrometry (MDRD-IDMS) equations were compared to simultaneous changes in isotope GFR (ΔiGFR) in renal transplant patients who had at least four scans. Results: Total number of patients (iGFR scans) was 99 (772) while the corresponding numbers in CKDT stages 1–4 were 33 (103), 69 (239), 75 (316) and 37 (96), respectively. Measurement error [(ΔeGFR – ΔiGFR) × 100/ΔiGFR] (median ± IQR, interquartile range) estimated from CG and MDRD-IDMS slopes were –414.29 ± 276.16% and –342.86 ± 210.18% (stage 1); –350.00 ± 301.22% and –300.00 ± 525.00% (stage 2); –26.02 ± 404.38% and –26.58 ± 423.13% (stage 3); 10.26 ± 142.18% and –76.92 ± 145.64% (stage 4), respectively. The proportion of patients with CG measurement error ≤1-fold in stages 1 and 2 of 12 and 14.5% was significantly (p < 0.05) lower than that of 36.3 and 52.8% at stages 3 and 4, respectively. Similar measurement errors were observed for MDRD-IDMS. Conclusions: Transplant GFR slope prediction is affected by the degree of renal dysfunction. Errors in slope prediction are much higher in those with better function and thus add another limitation for eGFR use in longitudinal studies on progressive graft dysfunction.

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Section: Discussionsupporting

confidence: 70%

Measurement Error in Estimated GFR Slopes across Transplant Chronic Kidney Disease Stages

Hossain¹,

Attia²,

Shoker³

2009

Am J Nephrol

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“…Data from a multicenter study pointed the 1 year estimated glomerular filtration rate to be the most relevant predictor of long term graft function. The impact of DGF and acute rejection on the long term graft function appeared to be fully mediated by their influence on the 1 year GFR (Salvadori et al, 2006). Similar to us, three studies found allograft function at 1 year to be a significant and independent predictor of graft outcome in children (Filler et al, 2002;Mitsnefes et al, 2003;Muscheites et al, 2009).…”

Section: Discussionsupporting

confidence: 65%

Factors Related to Graft Outcome in Pediatric Renal Transplantation: a Single Center Study

Herman¹,

Damme‐Lombaerts²

2011

After the Kidney Transplant - The Patients and Their Allograft

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“…387 In addition, several analyses have suggested that renal function at 1 year post transplant is a good predictor of long-term graft survival. 334,340,[388][389][390] Throughout this section it should be noted that graft survival and failure does not include DWFG, that is, considering only people who are alive and who become dependent on dialysis or require retransplantation.…”

Section: Estimation Of Graft Survivalmentioning

confidence: 99%

Immunosuppressive therapy for kidney transplantation in adults: a systematic review and economic model

Jones-Hughes

Snowsill

Haasova

et al. 2016

Health Technol Assess

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BackgroundEnd-stage renal disease is a long-term irreversible decline in kidney function requiring renal replacement therapy: kidney transplantation, haemodialysis or peritoneal dialysis. The preferred option is kidney transplantation, followed by immunosuppressive therapy (induction and maintenance therapy) to reduce the risk of kidney rejection and prolong graft survival.ObjectivesTo review and update the evidence for the clinical effectiveness and cost-effectiveness of basiliximab (BAS) (Simulect®, Novartis Pharmaceuticals UK Ltd) and rabbit anti-human thymocyte immunoglobulin (rATG) (Thymoglobulin®, Sanofi) as induction therapy, and immediate-release tacrolimus (TAC) (Adoport®, Sandoz; Capexion®, Mylan; Modigraf®, Astellas Pharma; Perixis®, Accord Healthcare; Prograf®, Astellas Pharma; Tacni®, Teva; Vivadex®, Dexcel Pharma), prolonged-release tacrolimus (Advagraf®Astellas Pharma), belatacept (BEL) (Nulojix®, Bristol-Myers Squibb), mycophenolate mofetil (MMF) (Arzip®, Zentiva; CellCept®, Roche Products; Myfenax®, Teva), mycophenolate sodium (MPS) (Myfortic®, Novartis Pharmaceuticals UK Ltd), sirolimus (SRL) (Rapamune®, Pfizer) and everolimus (EVL) (Certican®, Novartis) as maintenance therapy in adult renal transplantation.MethodsClinical effectiveness searches were conducted until 18 November 2014 in MEDLINE (via Ovid), EMBASE (via Ovid), Cochrane Central Register of Controlled Trials (via Wiley Online Library) and Web of Science (via ISI), Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects and Health Technology Assessment (The Cochrane Library via Wiley Online Library) and Health Management Information Consortium (via Ovid). Cost-effectiveness searches were conducted until 18 November 2014 using a costs or economic literature search filter in MEDLINE (via Ovid), EMBASE (via Ovid), NHS Economic Evaluation Database (via Wiley Online Library), Web of Science (via ISI), Health Economic Evaluations Database (via Wiley Online Library) and the American Economic Association’s electronic bibliography (via EconLit, EBSCOhost). Included studies were selected according to predefined methods and criteria. A random-effects model was used to analyse clinical effectiveness data (odds ratios for binary data and mean differences for continuous data). Network meta-analyses were undertaken within a Bayesian framework. A new discrete time–state transition economic model (semi-Markov) was developed, with acute rejection, graft function (GRF) and new-onset diabetes mellitus used to extrapolate graft survival. Recipients were assumed to be in one of three health states: functioning graft, graft loss or death.ResultsEighty-nine randomised controlled trials (RCTs), of variable quality, were included. For induction therapy, no treatment appeared more effective than another in reducing graft loss or mortality. Compared with placebo/no induction, rATG and BAS appeared more effective in reducing biopsy-proven acute rejection (BPAR) and BAS appeared more effective at improving GRF. For maintenance therapy, no treatment was better for all outcomes and no treatment appeared most effective at reducing graft loss. BEL + MMF appeared more effective than TAC + MMF and SRL + MMF at reducing mortality. MMF + CSA (ciclosporin), TAC + MMF, SRL + TAC, TAC + AZA (azathioprine) and EVL + CSA appeared more effective than CSA + AZA and EVL + MPS at reducing BPAR. SRL + AZA, TAC + AZA, TAC + MMF and BEL + MMF appeared to improve GRF compared with CSA + AZA and MMF + CSA. In the base-case deterministic and probabilistic analyses, BAS, MMF and TAC were predicted to be cost-effective at £20,000 and £30,000 per quality-adjusted life-year (QALY). When comparing all regimens, only BAS + TAC + MMF was cost-effective at £20,000 and £30,000 per QALY.LimitationsFor included trials, there was substantial methodological heterogeneity, few trials reported follow-up beyond 1 year, and there were insufficient data to perform subgroup analysis. Treatment discontinuation and switching were not modelled.Future workHigh-quality, better-reported, longer-term RCTs are needed. Ideally, these would be sufficiently powered for subgroup analysis and include health-related quality of life as an outcome.ConclusionOnly a regimen of BAS induction followed by maintenance with TAC and MMF is likely to be cost-effective at £20,000–30,000 per QALY.Study registrationThis study is registered as PROSPERO CRD42014013189.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Estimated One-Year Glomerular Filtration Rate is the Best Predictor of Long-term Graft Function Following Renal Transplant

Abstract: The findings of this study corroborate and augment data from previous registry surveys, and confirm the importance of observational studies in investigating the role of peritransplant parameters on long-term graft outcome.

Cited by 100 publications

References 21 publications

Measurement Error in Estimated GFR Slopes across Transplant Chronic Kidney Disease Stages

Measurement Error in Estimated GFR Slopes across Transplant Chronic Kidney Disease Stages

Factors Related to Graft Outcome in Pediatric Renal Transplantation: a Single Center Study

Immunosuppressive therapy for kidney transplantation in adults: a systematic review and economic model

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