The effect of delayed graft function on graft and patient survival in kidney transplantation: an approach using competing events analysis

• Type: Article in International Scientific Journal
• Date: 2015

Authors

Isabel Fonseca (Author) Other; Laetitia Teixeira (Author) Other; Jorge Malheiro (Author) Other; La Salete Martins (Author) Other; Leonidio Dias (Author) Other; Antonio Castro Henriques (Author) Other; Denisa Mendonca (Author) ICBAS

Journal

Title: Transplant International

Vol. 28

Pages: 738-750

ISSN: 0934-0874

Publisher: Wiley-Blackwell

Indexing

ISI Web of Knowledge - 36 Citations

Scopus - 39 Citations

Scientific classification

FOS: Medical and Health sciences > Clinical medicine

Other information

Authenticus ID: P-00G-4VC

DOI: 10.1111/tri.12543

Abstract (EN): ObjectiveIn kidney transplantation, the impact of delayed graft function (DGF) on long-term graft and patient survival is controversial. We examined the impact of DGF on graft and recipient survival by accounting for the possibility that death with graft function may act as a competing risk for allograft failure. Study design and SettingWe used data from 1281 adult primary deceased-donor kidney recipients whose allografts functioned at least 1year. ResultsThe probability of graft loss occurrence is overestimated using the complement of Kaplan-Meier estimates (1-KM). Both the cause-specific Cox proportional hazard regression model (standard Cox) and the subdistribution hazard regression model proposed by Fine and Gray showed that DGF was associated with shorter time to graft failure (csHR=2.0, P=0.002; sHR=1.57, P=0.009), independent of acute rejection (AR) and after adjusting for traditional factors associated with graft failure. Regarding patient survival, DGF was a predictor of patient death using the cause-specific Cox model (csHR=1.57, P=0.029) but not using the subdistribution model. ConclusionsThe probability of graft loss from competing end points should not be reported with the 1-KM. Application of a regression model for subdistribution hazard showed that, independent of AR, DGF has a detrimental effect on long-term graft survival, but not on patient survival.

Language: English

Type (Professor's evaluation): Scientific

No. of pages: 13