Mortality Prediction after the First Year of Kidney Transplantation: An Observational Study on Two European Cohorts

PLoS One. 2016 May 6;11(5):e0155278. doi: 10.1371/journal.pone.0155278. eCollection 2016.

Abstract

After the first year post transplantation, prognostic mortality scores in kidney transplant recipients can be useful for personalizing medical management. We developed a new prognostic score based on 5 parameters and computable at 1-year post transplantation. The outcome was the time between the first anniversary of the transplantation and the patient's death with a functioning graft. Afterwards, we appraised the prognostic capacities of this score by estimating time-dependent Receiver Operating Characteristic (ROC) curves from two prospective and multicentric European cohorts: the DIVAT (Données Informatisées et VAlidées en Transplantation) cohort composed of patients transplanted between 2000 and 2012 in 6 French centers; and the STCS (Swiss Transplant Cohort Study) cohort composed of patients transplanted between 2008 and 2012 in 6 Swiss centers. We also compared the results with those of two existing scoring systems: one from Spain (Hernandez et al.) and one from the United States (the Recipient Risk Score, RRS, Baskin-Bey et al.). From the DIVAT validation cohort and for a prognostic time at 10 years, the new prognostic score (AUC = 0.78, 95%CI = [0.69, 0.85]) seemed to present significantly higher prognostic capacities than the scoring system proposed by Hernandez et al. (p = 0.04) and tended to perform better than the initial RRS (p = 0.10). By using the Swiss cohort, the RRS and the the new prognostic score had comparable prognostic capacities at 4 years (AUC = 0.77 and 0.76 respectively, p = 0.31). In addition to the current available scores related to the risk to return in dialysis, we recommend to further study the use of the score we propose or the RRS for a more efficient personalized follow-up of kidney transplant recipients.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Cohort Studies
  • Decision Making
  • Europe
  • Humans
  • Kidney Transplantation / mortality*
  • Prognosis
  • Survival Analysis

Grants and funding

This work was supported by a grant from the French National Agency of Research (ANR-11-JSV1-0008-01) for the methodological developments, by a grant from the French Ministry of Health (PHRC, PROG/11/85, 2011) for the clinical expertise and the data management and by Roche Laboratory for supporting the data collection in the DIVAT network. The STCS is supported by the Swiss National Science Foundation (grant 33CS30-148512), the Swiss University Hospitals and Transplant centers. The funders played no part in study design, data collection and analysis, decision to publish, or preparation of the manuscript.