Development and validation of a prognostic index for allograft outcome in kidney recipients with transplant glomerulopathy.
Bottom Line: Based on the Cox model, we developed a prognostic index and classified patients into risk groups.The hazard ratios were 2.18 (median survival 19 months) and 16.27 (median survival 1.6 months), respectively, for patients in the medium and high-risk groups, compared to the low-risk group (median survival 47 months).Our prognostic index model did well in measures of discrimination and calibration.
We studied 92 patients with transplant glomerulopathy to develop a prognostic index based on the risk factors for allograft failure within five years of diagnosis (Development cohort). During 60 months (median) follow-up, 64 patients developed allograft failure. A chronic-inflammation score generated by combining Banff ci, ct and ti scores, serum creatinine and proteinuria at biopsy, were independent risk factors for allograft failure. Based on the Cox model, we developed a prognostic index and classified patients into risk groups. Compared to the low-risk group (median allograft survival over 60 months from diagnosis), patients in the medium risk group had a hazard ratio of 2.83 (median survival 25 months), while those in the high-risk group had a hazard ratio of 5.96 (median survival 3.7 months). We next evaluated the performance of the prognostic index in an independent external cohort of 47 patients with transplant glomerulopathy (Validation cohort). The hazard ratios were 2.18 (median survival 19 months) and 16.27 (median survival 1.6 months), respectively, for patients in the medium and high-risk groups, compared to the low-risk group (median survival 47 months). Our prognostic index model did well in measures of discrimination and calibration. Thus, risk stratification of transplant glomerulopathy based on our prognostic index may provide informative insight for both the patient and physician regarding prognosis and treatment.
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Mentions: The Validation cohort included 47 clinically indicated kidney allograft biopsies from 47 kidney transplant recipients with TG from the Henri Mondor Hospital, Créteil, France (Supplementary Table 1). Criteria for diagnosis, follow up and outcome was similar to that of the Development cohort. Median follow up was 60 months from the diagnosis. Thirty-one (66%) patients developed graft failure at 17 (2–30) months from the diagnosis. The 16 (34%) patients who did not have allograft failure were followed for 60 (41–60) months from the diagnosis. We applied the same model (equation) generated in the Development cohort to the patients in the Validation cohort to calculate the PI and used the same cut off values to define the three risk groups in the Validation cohort (Supplementary Figure 1). The median allograft survival was 47, 19 and 1.6 months for the three risk groups (Figure 5). The HR was 2.18 (0.94–5.02) and 16.27 (4.62–57.28) for the medium and high risk groups, respectively, compared to the low risk group.
No MeSH data available.