A Novel Prognostic Index for Mortality in Renal Transplant Recipients After Hospitalization

Transplantation. 2005 Feb 15;79(3):337-43. doi: 10.1097/01.tp.0000151003.30089.31.

Abstract

Background: Prognostic indices that estimate long-term mortality are essential not only to compare different clinical studies and populations but also to perform the most appropriate therapeutic interventions. All-cause mortality is high after renal transplantation (RTx), but no prognostic index has focused on predicting mortality in RTx. We developed and tested a prognostic index for mortality in RTx after hospitalization.

Methods: We retrospectively analyzed survival in 1,293 RTx recipients who were randomly assigned to two groups: a modeling population (n=646), used to create the new index, and a testing population (n=647), used to test this index. Patients were stratified into three risk groups (low, medium, and high) by combining peritransplant risk factors for mortality (beta-coefficient), using a simple eight-point check list: age, pretransplant cardiovascular disease, renal dysfunction at discharge, cardiac hypertrophy, vascular calcification, diabetes, time on dialysis, and acute tubular necrosis.

Results: Overall lower survival rates were observed with increasing risk classes in the testing population (log-rank test=18; P=0.0001). The 8-year survival rates ranged from 94% in the lowest-risk group to 59% in the highest-risk group. The area under the receiver operating characteristic curve was 0.63. Mortality risk (Cox analysis) significantly increased with increasing risk classes (medium risk: relative risk=3.8, 95% confidence interval=1.5-9.5, P=0.004; high risk: relative risk=6.3, 95% confidence interval=2.4-16.2, P=0.0001).

Conclusions: This simple prognostic index applicable at the bedside may accurately predict survival in RTx recipients after discharge. Consequently, targeted treatment interventions may be indicated for minimizing mortality, especially in high-risk groups.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Calcinosis / epidemiology
  • Cardiovascular Diseases / epidemiology
  • Diabetic Nephropathies / epidemiology
  • European Continental Ancestry Group
  • Female
  • Hospitalization
  • Humans
  • Kidney Transplantation / mortality*
  • Male
  • Middle Aged
  • Peritoneal Dialysis / adverse effects
  • Prognosis
  • Renal Dialysis / adverse effects
  • Retrospective Studies
  • Risk Factors
  • Spain
  • Survival Analysis
  • Time Factors