An adjustable predictive score of graft survival in kidney transplant patients and the levels of risk linked to de novo donor-specific anti-HLA antibodies

PLoS One. 2017 Jul 3;12(7):e0180236. doi: 10.1371/journal.pone.0180236. eCollection 2017.

Abstract

Most predictive models and scores of graft survival in renal transplantation include factors known before transplant or at the end of the first year. They cannot be updated thereafter, even in patients developing donor-specific anti-HLA antibodies and acute rejection.We developed a conditional and adjustable score for prediction of graft failure (AdGFS) up to 10 years post-transplantation in 664 kidney transplant patients. AdGFS was externally validated and calibrated in 896 kidney transplant patients.The final model included five baseline factors (pretransplant non donor-specific anti-HLA antibodies, donor age, serum creatinine measured at 1 year, longitudinal serum creatinine clusters during the first year, proteinuria measured at 1 year), and two predictors updated over time (de novo donor-specific anti-HLA antibodies and first acute rejection). AdGFS was able to stratify patients into four risk-groups, at different post-transplantation times. It showed good discrimination (time-dependent ROC curve at ten years: 0.83 (CI95% 0.76-0.89).

Publication types

  • Validation Study

MeSH terms

  • Adult
  • Autoantibodies / immunology*
  • Cluster Analysis
  • Creatinine / blood
  • Female
  • Graft Rejection
  • Graft Survival*
  • HLA Antigens / immunology*
  • Humans
  • Kidney Transplantation*
  • Male
  • Middle Aged
  • Tissue Donors*

Substances

  • Autoantibodies
  • HLA Antigens
  • Creatinine

Grants and funding

The Astre database was funded by Roche, Astellas and Sanofi. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.