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

• Tipo: Artigo em Revista Científica Internacional
• Data: 2015

Autores

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

Revista

Título: Transplant International

Vol. 28

Páginas: 738-750

ISSN: 0934-0874

Editora: Wiley-Blackwell

Indexação

ISI Web of Knowledge - 36 Citações

Scopus - 39 Citações

Classificação Científica

FOS: Ciências médicas e da saúde > Medicina clínica

Outras Informações

ID Authenticus: 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.

Idioma: Inglês

Tipo (Avaliação Docente): Científica

Nº de páginas: 13