Kidney allograft failure in the steroid-free immunosuppression era: A matched case-control study

Mohamad M. Alkadi, Jim Kim, Meredith J. Aull, Joseph E. Schwartz, John R. Lee, Anthony Watkins, Jun B. Lee, Darshana M. Dadhania, Surya V. Seshan, David Serur, Sandip Kapur, Manikkam Suthanthiran, Choli Hartono, Thangamani Muthukumar

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

We studied the causes and predictors of death-censored kidney allograft failure among 1670 kidney recipients transplanted at our center in the corticosteroid-free maintenance immunosuppression era. As of January 1, 2012, we identified 137 recipients with allograft failure; 130 of them (cases) were matched 1-1 for recipient age, calendar year of transplant, and donor type with 130 recipients with functioning grafts (controls). Median time to allograft failure was 29 months (interquartile range: 18-51). Physician-validated and biopsy-confirmed categories of allograft failure were as follows: acute rejection (21%), glomerular disease (19%), transplant glomerulopathy (13%), interstitial fibrosis tubular atrophy (10%), and polyomavirus-associated nephropathy (7%). Graft failures were attributed to medical conditions in 21% and remained unresolved in 9%. Donor race, donor age, human leukocyte antigen mismatches, serum creatinine, urinary protein, acute cellular rejection, acute antibody-mediated rejection, BK viremia, and CMV viremia were associated with allograft failure. Independent predictors of allograft failure were acute cellular rejection (odds ratio: 18.31, 95% confidence interval: 5.28-63.45) and urine protein ≥1 g/d within the first year post-transplantation (5.85, 2.37-14.45). Serum creatinine ≤1.5 mg/dL within the first year post-transplantation reduced the odds (0.29, 0.13-0.64) of allograft failure. Our study has identified modifiable risk factors to reduce the burden of allograft failure.

Original languageEnglish
Article numbere13117
JournalClinical Transplantation
Volume31
Issue number11
DOIs
Publication statusPublished - 1 Nov 2017
Externally publishedYes

Fingerprint

Immunosuppression
Renal Insufficiency
Allografts
Case-Control Studies
Steroids
Viremia
Tissue Donors
Transplants
Creatinine
Transplantation
Polyomavirus
HLA Antigens
Serum
Atrophy
Cause of Death
Adrenal Cortex Hormones
Proteins
Fibrosis
Odds Ratio
Maintenance

Keywords

  • biopsy
  • graft rejection
  • immunosuppression
  • polyomavirus
  • risk factors

ASJC Scopus subject areas

  • Transplantation

Cite this

Alkadi, M. M., Kim, J., Aull, M. J., Schwartz, J. E., Lee, J. R., Watkins, A., ... Muthukumar, T. (2017). Kidney allograft failure in the steroid-free immunosuppression era: A matched case-control study. Clinical Transplantation, 31(11), [e13117]. https://doi.org/10.1111/ctr.13117

Kidney allograft failure in the steroid-free immunosuppression era : A matched case-control study. / Alkadi, Mohamad M.; Kim, Jim; Aull, Meredith J.; Schwartz, Joseph E.; Lee, John R.; Watkins, Anthony; Lee, Jun B.; Dadhania, Darshana M.; Seshan, Surya V.; Serur, David; Kapur, Sandip; Suthanthiran, Manikkam; Hartono, Choli; Muthukumar, Thangamani.

In: Clinical Transplantation, Vol. 31, No. 11, e13117, 01.11.2017.

Research output: Contribution to journalArticle

Alkadi, MM, Kim, J, Aull, MJ, Schwartz, JE, Lee, JR, Watkins, A, Lee, JB, Dadhania, DM, Seshan, SV, Serur, D, Kapur, S, Suthanthiran, M, Hartono, C & Muthukumar, T 2017, 'Kidney allograft failure in the steroid-free immunosuppression era: A matched case-control study', Clinical Transplantation, vol. 31, no. 11, e13117. https://doi.org/10.1111/ctr.13117
Alkadi, Mohamad M. ; Kim, Jim ; Aull, Meredith J. ; Schwartz, Joseph E. ; Lee, John R. ; Watkins, Anthony ; Lee, Jun B. ; Dadhania, Darshana M. ; Seshan, Surya V. ; Serur, David ; Kapur, Sandip ; Suthanthiran, Manikkam ; Hartono, Choli ; Muthukumar, Thangamani. / Kidney allograft failure in the steroid-free immunosuppression era : A matched case-control study. In: Clinical Transplantation. 2017 ; Vol. 31, No. 11.
@article{0d62de5ad9ea4bf7b4376ebdcb595b6f,
title = "Kidney allograft failure in the steroid-free immunosuppression era: A matched case-control study",
abstract = "We studied the causes and predictors of death-censored kidney allograft failure among 1670 kidney recipients transplanted at our center in the corticosteroid-free maintenance immunosuppression era. As of January 1, 2012, we identified 137 recipients with allograft failure; 130 of them (cases) were matched 1-1 for recipient age, calendar year of transplant, and donor type with 130 recipients with functioning grafts (controls). Median time to allograft failure was 29 months (interquartile range: 18-51). Physician-validated and biopsy-confirmed categories of allograft failure were as follows: acute rejection (21{\%}), glomerular disease (19{\%}), transplant glomerulopathy (13{\%}), interstitial fibrosis tubular atrophy (10{\%}), and polyomavirus-associated nephropathy (7{\%}). Graft failures were attributed to medical conditions in 21{\%} and remained unresolved in 9{\%}. Donor race, donor age, human leukocyte antigen mismatches, serum creatinine, urinary protein, acute cellular rejection, acute antibody-mediated rejection, BK viremia, and CMV viremia were associated with allograft failure. Independent predictors of allograft failure were acute cellular rejection (odds ratio: 18.31, 95{\%} confidence interval: 5.28-63.45) and urine protein ≥1 g/d within the first year post-transplantation (5.85, 2.37-14.45). Serum creatinine ≤1.5 mg/dL within the first year post-transplantation reduced the odds (0.29, 0.13-0.64) of allograft failure. Our study has identified modifiable risk factors to reduce the burden of allograft failure.",
keywords = "biopsy, graft rejection, immunosuppression, polyomavirus, risk factors",
author = "Alkadi, {Mohamad M.} and Jim Kim and Aull, {Meredith J.} and Schwartz, {Joseph E.} and Lee, {John R.} and Anthony Watkins and Lee, {Jun B.} and Dadhania, {Darshana M.} and Seshan, {Surya V.} and David Serur and Sandip Kapur and Manikkam Suthanthiran and Choli Hartono and Thangamani Muthukumar",
year = "2017",
month = "11",
day = "1",
doi = "10.1111/ctr.13117",
language = "English",
volume = "31",
journal = "Clinical Transplantation",
issn = "0902-0063",
publisher = "Wiley-Blackwell",
number = "11",

}

TY - JOUR

T1 - Kidney allograft failure in the steroid-free immunosuppression era

T2 - A matched case-control study

AU - Alkadi, Mohamad M.

AU - Kim, Jim

AU - Aull, Meredith J.

AU - Schwartz, Joseph E.

AU - Lee, John R.

AU - Watkins, Anthony

AU - Lee, Jun B.

AU - Dadhania, Darshana M.

AU - Seshan, Surya V.

AU - Serur, David

AU - Kapur, Sandip

AU - Suthanthiran, Manikkam

AU - Hartono, Choli

AU - Muthukumar, Thangamani

PY - 2017/11/1

Y1 - 2017/11/1

N2 - We studied the causes and predictors of death-censored kidney allograft failure among 1670 kidney recipients transplanted at our center in the corticosteroid-free maintenance immunosuppression era. As of January 1, 2012, we identified 137 recipients with allograft failure; 130 of them (cases) were matched 1-1 for recipient age, calendar year of transplant, and donor type with 130 recipients with functioning grafts (controls). Median time to allograft failure was 29 months (interquartile range: 18-51). Physician-validated and biopsy-confirmed categories of allograft failure were as follows: acute rejection (21%), glomerular disease (19%), transplant glomerulopathy (13%), interstitial fibrosis tubular atrophy (10%), and polyomavirus-associated nephropathy (7%). Graft failures were attributed to medical conditions in 21% and remained unresolved in 9%. Donor race, donor age, human leukocyte antigen mismatches, serum creatinine, urinary protein, acute cellular rejection, acute antibody-mediated rejection, BK viremia, and CMV viremia were associated with allograft failure. Independent predictors of allograft failure were acute cellular rejection (odds ratio: 18.31, 95% confidence interval: 5.28-63.45) and urine protein ≥1 g/d within the first year post-transplantation (5.85, 2.37-14.45). Serum creatinine ≤1.5 mg/dL within the first year post-transplantation reduced the odds (0.29, 0.13-0.64) of allograft failure. Our study has identified modifiable risk factors to reduce the burden of allograft failure.

AB - We studied the causes and predictors of death-censored kidney allograft failure among 1670 kidney recipients transplanted at our center in the corticosteroid-free maintenance immunosuppression era. As of January 1, 2012, we identified 137 recipients with allograft failure; 130 of them (cases) were matched 1-1 for recipient age, calendar year of transplant, and donor type with 130 recipients with functioning grafts (controls). Median time to allograft failure was 29 months (interquartile range: 18-51). Physician-validated and biopsy-confirmed categories of allograft failure were as follows: acute rejection (21%), glomerular disease (19%), transplant glomerulopathy (13%), interstitial fibrosis tubular atrophy (10%), and polyomavirus-associated nephropathy (7%). Graft failures were attributed to medical conditions in 21% and remained unresolved in 9%. Donor race, donor age, human leukocyte antigen mismatches, serum creatinine, urinary protein, acute cellular rejection, acute antibody-mediated rejection, BK viremia, and CMV viremia were associated with allograft failure. Independent predictors of allograft failure were acute cellular rejection (odds ratio: 18.31, 95% confidence interval: 5.28-63.45) and urine protein ≥1 g/d within the first year post-transplantation (5.85, 2.37-14.45). Serum creatinine ≤1.5 mg/dL within the first year post-transplantation reduced the odds (0.29, 0.13-0.64) of allograft failure. Our study has identified modifiable risk factors to reduce the burden of allograft failure.

KW - biopsy

KW - graft rejection

KW - immunosuppression

KW - polyomavirus

KW - risk factors

UR - http://www.scopus.com/inward/record.url?scp=85032695010&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85032695010&partnerID=8YFLogxK

U2 - 10.1111/ctr.13117

DO - 10.1111/ctr.13117

M3 - Article

C2 - 28921709

AN - SCOPUS:85032695010

VL - 31

JO - Clinical Transplantation

JF - Clinical Transplantation

SN - 0902-0063

IS - 11

M1 - e13117

ER -