Prognostic value for long-term graft survival of estimated glomerular filtration rate and proteinuria quantified at 3 months after kidney transplantation

Mottola, Clément; Girerd, Nicolas; Duarte, Kévin; Aarnink, Alice; Giral, Magali; Dantal, Jacques; Garrigue, Valérie; Mourad, Georges; Buron, Fanny; Morélon, Emmanuel; Ladrière, Marc; Kessler, Michèle; Frimat, Luc; Girerd, Sophie

doi:10.1093/ckj/sfaa044

Cited by 16 publications

(17 citation statements)

References 34 publications

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“…In a French single-center study, the 3-month eGFR <45 mL/min/1.73 m 2 was associated with lower long-term death-censored graft survival. 48 Likewise, we found that an eGFR <45 ml/min/ 1.73 m 2 at one month post-transplantation was a strong predictor of a lower patient and graft survival in LN patients. Our results suggest that very early risk stratification using the 1-month post-transplantation eGFR has predictive value.…”

Section: Discussionsupporting

confidence: 53%

Kidney transplantation outcomes in lupus nephritis: A 37-year single-center experience from Latin America

Rodelo

González

Ustáriz

et al. 2021

Lupus

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Objective We assessed patient and graft outcomes and prognostic factors in kidney transplantation in patients with end-stage kidney disease (ESKD) secondary to lupus nephritis (LN) undergoing kidney transplantation from August 1977 to December 2014 in a Latin American single center. Methods The primary endpoint was patient survival, and the secondary endpoints were death-censored graft survival for the first renal transplant and the rate of recurrent LN (RLN). Kaplan–Meier method was used for survival analysis. Factors predicting patient and death-censored graft survivals were examined by Cox proportional-hazards regression analyses. Results 185 patients were retrospectively evaluated. Patient survival rates were 88% at one year, 82% at three years, 78% at five years, and 67% at ten years. Death-censored graft survival for the first renal transplant was 93% at one year, 89% at three years, 87% at five years, and 80% at ten years. RLN was diagnosed in 2 patients (1.08%), but no graft was lost because of RLN. Thirty-nine (21.1%) patients died, and 65 (35.1%) patients experienced graft loss during the follow-up. By multivariable analyses, older recipient age and 1-month posttransplantation eGFR <45 ml/min/1.73m2 were associated with lower patient survival and an increased risk of graft loss, while induction immunosuppressive therapy exerted a protective effect on patients’ survival. In the subgroup of patients in whom disease activity was measured at the time of transplantation, a higher SLEDAI score was also associated with lower patient survival and an increased risk of graft loss. Conclusion In a mostly Mestizo population, kidney transplantation is an excellent therapeutic alternative in LN patients with ESKD. Older recipient age, an eGFR <45 ml/min/1.73m2 at one month posttransplantation, and disease activity at the time of transplantation are predictive of a lower patient and death-censored graft survival, while induction immunosuppressive therapy has a protective effect on patient survival. RLN is rare and does not influence the risk of graft loss.

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Section: Discussionsupporting

confidence: 53%

Kidney transplantation outcomes in lupus nephritis: A 37-year single-center experience from Latin America

Rodelo

González

Ustáriz

et al. 2021

Lupus

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“…Proteinuria showed the strongest correlation with the deterioration of graft function (OR = 3.69). Mottola C. et al also showed a strong correlation between proteinuria and poor graft survival but measured only within 1 year of Ktx [ 20 ]. Proteinuria is also a risk factor for death in the first post-transplant year [ 10 ] and cardiovascular diseases in KTRs [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Salivary Indoxyl Sulfate with Proteinuria for Predicting Graft Deterioration in Kidney Transplant Recipients

Korytowska

Wyczalkowska-Tomasik

Pączek

et al. 2021

Toxins

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Acute kidney injury (AKI) is a significant risk factor for developing chronic kidney disease and progression to end-stage renal disease in elderly patients. AKI is also a relatively common complication after kidney transplantation (KTx) associated with graft failure. Since the lifespan of a transplanted kidney is limited, the risk of the loss/deterioration of graft function (DoGF) should be estimated to apply the preventive treatment. The collection of saliva and urine is more convenient than collecting blood and can be performed at home. The study aimed to verify whether non-invasive biomarkers, determined in saliva and urine, may be useful in the prediction of DoGF in kidney transplant recipients (KTRs) (n = 92). Salivary and serum toxins (p-cresol sulfate, pCS; indoxyl sulfate, IS) concentrations were determined using liquid chromatography-tandem mass spectrometry (LC-MS/MS). Urinary proteins, hemoglobin, and glucose were measured using a semi-quantitative strip test. Salivary IS (odds ratio (OR) = 1.19), and proteinuria (OR = 3.69) were demonstrated as independent factors for the prediction of DoGF. Satisfactory discriminatory power (area under the receiver operating characteristic curve (AUC) = 0.71 ± 0.07) and calibration of the model were obtained. The model showed that categories of the increasing probability of the risk of DoGF are associated with the decreased risk of graft survival. The non-invasive diagnostic biomarkers are a useful screening tool to identify high-risk patients for DoGF.

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“…Functional or well-regenerated kidneys free recipients from dialysis, and a well-regernerated kidney congenitally determines the subsequent incidence of complications as well as the life span of the graft. Many studies have proven that well-regenerated renal function decreases the risk of long-term graft loss ( 2 , 3 , 15 ). Thus, renal function is deemed as a surrogate endpoint.…”

Section: Discussionmentioning

confidence: 99%

Deep Learning Algorithms for the Prediction of Posttransplant Renal Function in Deceased-Donor Kidney Recipients: A Preliminary Study Based on Pretransplant Biopsy

Luo

Liang

et al. 2022

Front. Med.

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BackgroundPosttransplant renal function is critically important for kidney transplant recipients. Accurate prediction of graft function would greatly help in deciding acceptance or discard of allocated kidneys.Methods: Whole-slide images (WSIs) of H&E-stained donor kidney biopsies at × 200 magnification between January 2015 and December 2019 were collected. The clinical characteristics of each donor and corresponding recipient were retrieved. Graft function was indexed with a stable estimated glomerular filtration rate (eGFR) and reduced graft function (RGF). We used convolutional neural network (CNN)-based models, such as EfficientNet-B5, Inception-V3, and VGG19 for the prediction of these two outcomes.ResultsIn total, 219 recipients with H&E-stained slides of the donor kidneys were included for analysis [biopsies from standard criteria donor (SCD)/expanded criteria donor (ECD) was 191/28]. The results showed distinct improvements in the prediction performance of the deep learning algorithm plus the clinical characteristics model. The EfficientNet-B5 plus clinical data model showed the lowest mean absolute error (MAE) and root mean square error (RMSE). Compared with the clinical data model, the area under the receiver operating characteristic (ROC) curve (AUC) of the clinical data plus image model for eGFR classification increased from 0.69 to 0.83. In addition, the predictive performance for RGF increased from 0.66 to 0.80. Gradient-weighted class activation mappings (Grad-CAMs) showed that the models localized the areas of the tubules and interstitium near the glomeruli, which were discriminative features for RGF.ConclusionOur results preliminarily show that deep learning for formalin-fixed paraffin-embedded H&E-stained WSIs improves graft function prediction accuracy for deceased-donor kidney transplant recipients.

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Prognostic value for long-term graft survival of estimated glomerular filtration rate and proteinuria quantified at 3 months after kidney transplantation

Cited by 16 publications

References 34 publications

Kidney transplantation outcomes in lupus nephritis: A 37-year single-center experience from Latin America

Kidney transplantation outcomes in lupus nephritis: A 37-year single-center experience from Latin America

Evaluation of Salivary Indoxyl Sulfate with Proteinuria for Predicting Graft Deterioration in Kidney Transplant Recipients

Deep Learning Algorithms for the Prediction of Posttransplant Renal Function in Deceased-Donor Kidney Recipients: A Preliminary Study Based on Pretransplant Biopsy

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