Cargando…

Transplant and Recipient Factors in Prediction of Kidney Transplant Outcomes: A UK-Wide Paired Analysis

Background: In kidney transplantation, the relative contribution of various donor, procedure and recipient-related factors on clinical outcomes is unknown. Previous paired studies have largely focused on examining factors predicting early outcomes, where the effect of donor factors is thought to be...

Descripción completa

Detalles Bibliográficos
Autores principales: Dumbill, Richard, Jaques, Roderick, Robb, Matthew, Johnson, Rachel, Ploeg, Rutger J., Kaisar, Maria E., Sharples, Edward J.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9024822/
https://www.ncbi.nlm.nih.gov/pubmed/35456312
http://dx.doi.org/10.3390/jcm11082222
_version_ 1784690703063842816
author Dumbill, Richard
Jaques, Roderick
Robb, Matthew
Johnson, Rachel
Ploeg, Rutger J.
Kaisar, Maria E.
Sharples, Edward J.
author_facet Dumbill, Richard
Jaques, Roderick
Robb, Matthew
Johnson, Rachel
Ploeg, Rutger J.
Kaisar, Maria E.
Sharples, Edward J.
author_sort Dumbill, Richard
collection PubMed
description Background: In kidney transplantation, the relative contribution of various donor, procedure and recipient-related factors on clinical outcomes is unknown. Previous paired studies have largely focused on examining factors predicting early outcomes, where the effect of donor factors is thought to be most important. Here, we sought to examine the relationship between early and long-term outcomes in a UK-wide paired kidney analysis. Methods: UK Transplant Registry data covering 24,090 kidney transplants performed between 2001–2018, where both kidneys from each donor were transplanted, were analysed. Case-control studies were constructed using matched pairs of kidneys from the same donor discordant for outcome, to delineate the impact of transplant and recipient factors on longer-term outcomes. Results: Multivariable conditional logistic regression identified HLA mismatch as an important predictor of prolonged delayed graft function (DGF), in the context of a paired study controlling for the influence of donor factors, even when adjusting for early acute rejection. Prolonged DGF, but not human leucocyte antigen (HLA) mismatch, strongly predicted 12-month graft function, and impaired 12-month graft function was associated with an increased risk of graft failure. Conclusions: This study indicates prolonged DGF is associated with adverse long-term outcomes and suggests that alloimmunity may contribute to prolonged DGF by a mechanism distinct from typical early acute rejection.
format Online
Article
Text
id pubmed-9024822
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher MDPI
record_format MEDLINE/PubMed
spelling pubmed-90248222022-04-23 Transplant and Recipient Factors in Prediction of Kidney Transplant Outcomes: A UK-Wide Paired Analysis Dumbill, Richard Jaques, Roderick Robb, Matthew Johnson, Rachel Ploeg, Rutger J. Kaisar, Maria E. Sharples, Edward J. J Clin Med Article Background: In kidney transplantation, the relative contribution of various donor, procedure and recipient-related factors on clinical outcomes is unknown. Previous paired studies have largely focused on examining factors predicting early outcomes, where the effect of donor factors is thought to be most important. Here, we sought to examine the relationship between early and long-term outcomes in a UK-wide paired kidney analysis. Methods: UK Transplant Registry data covering 24,090 kidney transplants performed between 2001–2018, where both kidneys from each donor were transplanted, were analysed. Case-control studies were constructed using matched pairs of kidneys from the same donor discordant for outcome, to delineate the impact of transplant and recipient factors on longer-term outcomes. Results: Multivariable conditional logistic regression identified HLA mismatch as an important predictor of prolonged delayed graft function (DGF), in the context of a paired study controlling for the influence of donor factors, even when adjusting for early acute rejection. Prolonged DGF, but not human leucocyte antigen (HLA) mismatch, strongly predicted 12-month graft function, and impaired 12-month graft function was associated with an increased risk of graft failure. Conclusions: This study indicates prolonged DGF is associated with adverse long-term outcomes and suggests that alloimmunity may contribute to prolonged DGF by a mechanism distinct from typical early acute rejection. MDPI 2022-04-15 /pmc/articles/PMC9024822/ /pubmed/35456312 http://dx.doi.org/10.3390/jcm11082222 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Dumbill, Richard
Jaques, Roderick
Robb, Matthew
Johnson, Rachel
Ploeg, Rutger J.
Kaisar, Maria E.
Sharples, Edward J.
Transplant and Recipient Factors in Prediction of Kidney Transplant Outcomes: A UK-Wide Paired Analysis
title Transplant and Recipient Factors in Prediction of Kidney Transplant Outcomes: A UK-Wide Paired Analysis
title_full Transplant and Recipient Factors in Prediction of Kidney Transplant Outcomes: A UK-Wide Paired Analysis
title_fullStr Transplant and Recipient Factors in Prediction of Kidney Transplant Outcomes: A UK-Wide Paired Analysis
title_full_unstemmed Transplant and Recipient Factors in Prediction of Kidney Transplant Outcomes: A UK-Wide Paired Analysis
title_short Transplant and Recipient Factors in Prediction of Kidney Transplant Outcomes: A UK-Wide Paired Analysis
title_sort transplant and recipient factors in prediction of kidney transplant outcomes: a uk-wide paired analysis
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9024822/
https://www.ncbi.nlm.nih.gov/pubmed/35456312
http://dx.doi.org/10.3390/jcm11082222
work_keys_str_mv AT dumbillrichard transplantandrecipientfactorsinpredictionofkidneytransplantoutcomesaukwidepairedanalysis
AT jaquesroderick transplantandrecipientfactorsinpredictionofkidneytransplantoutcomesaukwidepairedanalysis
AT robbmatthew transplantandrecipientfactorsinpredictionofkidneytransplantoutcomesaukwidepairedanalysis
AT johnsonrachel transplantandrecipientfactorsinpredictionofkidneytransplantoutcomesaukwidepairedanalysis
AT ploegrutgerj transplantandrecipientfactorsinpredictionofkidneytransplantoutcomesaukwidepairedanalysis
AT kaisarmariae transplantandrecipientfactorsinpredictionofkidneytransplantoutcomesaukwidepairedanalysis
AT sharplesedwardj transplantandrecipientfactorsinpredictionofkidneytransplantoutcomesaukwidepairedanalysis