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

Marine Lorent (1, 2) , Magali Giral (2, 3) , Manuel Pascual (4, 5) , Michael Koller (6) , Jürg Steiger (6) , Katy Trébern-Launay (1, 2) , Christophe Legendre (7, 8, 9) , Henri Kreis (7, 8, 9) , Georges Mourad (10, 11) , Valérie Garrigue (10) , Lionel Rostaing (12, 13) , Nassim Kamar (12, 13) , Michèle Kessler (14) , Marc Ladrière (14) , Emmanuel Morelon (15) , Fanny Buron (15) , Dela Golshayan (4, 5) , Yohann Foucher (1, 2)

1 Biostatistique, Recherche Clinique et Mesures Subjectives en Santé
2 U1064 Inserm - CRTI - Centre de Recherche en Transplantation et Immunologie
3 CIC biothérapies CBT 0503 [Nantes]
4 CHUV - Centre Hospitalier Universitaire Vaudois = Lausanne University Hospital [Lausanne]
5 UNIL - Université de Lausanne = University of Lausanne
6 University Hospital Basel [Basel]
7 Service Néphrologie et transplantation rénale Adultes [CHU Necker]
8 UPD5 - Université Paris Descartes - Paris 5
9 USPC - Université Sorbonne Paris Cité
10 CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]
11 Cellules Souches, Plasticité Cellulaire, Médecine Régénératrice et Immunothérapies (IRMB)
12 Service de Néphrologie - Hypertension Artérielle Dialyse - Transplantation
13 UT3 - Université Toulouse III - Paul Sabatier
14 Service de Néphrologie [CHRU Nancy]
15 Hôpital Edouard Herriot [CHU - HCL]

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.

Domaines: Médecine humaine et pathologie

Marine Lorent, Magali Giral, Manuel Pascual, Michael Koller, Jürg Steiger, et al.. Mortality Prediction after the First Year of Kidney Transplantation: An Observational Study on Two European Cohorts. PLoS ONE, 2016, 11 (5), pp.e0155278. ⟨10.1371/journal.pone.0155278⟩. ⟨hal-01868416⟩