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Poor long-term outcome in second kidney transplantation : a delayed event

Auteurs

• Trébern-Launay Katy - INSERM U1064 
  
  
• Foucher Yohann - Maître de Conférences en Biostatistique - HDR  - UFR de médecine - Université de Nantes 
  
  
• Giral Magali - PU-PH  - CHU de Nantes  
  
  
• Legendre C.
  
  
• Kreiss H
  
  
• Kessler M
  
  
• Ladrière M
  
  
• Kamar N
  
  
• Rostaing L
  
  
• Garrigue V
  
  
• Mourad G
  
  
• Morelon E
  
  
• Soulillou Jean-Paul
  
  
• Dantal J
  
  

Description

Nature : Articles dans une revue internationale
Thématique : Biostatistique et Mesures Subjectives en Santé
Rang : Rang A : publication porté par un membre de l'unité, dans le cadre de l'unité
Axe de recherche principal: Modèles pronostiques
Axe de recherche secondaire: Recherche Clinique
Sujet : Données Informatiques VAlidées en Transplantation

Trébern-Launay K, Foucher Y, Giral M, Legendre C, Kreiss H, Kessler M, Ladrière M, Kamar N, Rostaing L, Garrigue V, Mourad G, Morelon E, Soulillou JP, Dantal J (2012) Poor long-term outcome in second kidney transplantation : a delayed event. PLoS One, 7(10): e47915.

Lien

Résumé

BACKGROUND: Old studies reported a worse outcome for second transplant recipient (STR) than for first transplant recipient (FTR) mainly due to non-comparable populations with numbers confounding factors. More recent analysis, based on improved methodology by using multivariate regressions, challenged this generally accepted idea: the poor prognosis for STR is still under debate. METHODOLOGY: To assess the long-term patient-and-graft survival of STR compared to FTR, we performed an observational study based on the French DIVAT prospective cohort between 1996 and 2010 (N = 3103 including 641 STR). All patients were treated with a CNI, an mTOR inhibitor or belatacept in addition to steroids and mycophenolate mofetil for maintenance therapy. Patient-and-graft survival and acute rejection episode (ARE) were analyzed using Cox models adjusted for all potential confounding factors such as pre-transplant anti-HLA immunization. RESULTS: We showed that STR have a higher risk of graft failure than FTR (HR = 2.18, p = 0.0013) but that this excess risk was observed after few years of transplantation. There was no significant difference between STR and FTR in the occurrence of either overall ARE (HR = 1.01, p = 0.9675) or steroid-resistant ARE (HR = 1.27, p = 0.4087). CONCLUSIONS: The risk of graft failure following second transplantation remained consistently higher than that observed in first transplantation after adjusting for confounding factors. The rarely performed time-dependent statistical modeling may explain the heterogeneous conclusions of the literature concerning second transplantation outcomes. In clinical practice, physicians should not consider STR and FTR equally.

Abstract

BACKGROUND: Old studies reported a worse outcome for second transplant recipient (STR) than for first transplant recipient (FTR) mainly due to non-comparable populations with numbers confounding factors. More recent analysis, based on improved methodology by using multivariate regressions, challenged this generally accepted idea: the poor prognosis for STR is still under debate. METHODOLOGY: To assess the long-term patient-and-graft survival of STR compared to FTR, we performed an observational study based on the French DIVAT prospective cohort between 1996 and 2010 (N = 3103 including 641 STR). All patients were treated with a CNI, an mTOR inhibitor or belatacept in addition to steroids and mycophenolate mofetil for maintenance therapy. Patient-and-graft survival and acute rejection episode (ARE) were analyzed using Cox models adjusted for all potential confounding factors such as pre-transplant anti-HLA immunization. RESULTS: We showed that STR have a higher risk of graft failure than FTR (HR = 2.18, p = 0.0013) but that this excess risk was observed after few years of transplantation. There was no significant difference between STR and FTR in the occurrence of either overall ARE (HR = 1.01, p = 0.9675) or steroid-resistant ARE (HR = 1.27, p = 0.4087). CONCLUSIONS: The risk of graft failure following second transplantation remained consistently higher than that observed in first transplantation after adjusting for confounding factors. The rarely performed time-dependent statistical modeling may explain the heterogeneous conclusions of the literature concerning second transplantation outcomes. In clinical practice, physicians should not consider STR and FTR equally.

Projet(s) ayant donné lieu à cette publication

DIVAT-SPHERE - Axe 2 : Prédiction/pronostic à long-terme du patient transplanté

Thèse(s) ou stage(s) lié(s) à cette publication

Katy Trébern-Launay : Apport des modèles de survie relative dans la modélisation des patients transplantés rénaux : application à la cohorte DIVAT (soutenue le 24 octobre 2013)

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• Foucher Y, Giral M, Soulillou JP, Daurès JP (2007) A semi-Markov model for multistate and interval-censored data with multiple terminal events. Application in renal transplantatio. Statistics in Medicine, 26(30): 5381-93.
  
  
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Publications liées à l'axe principal de recherche (Modèles pronostiques)

• Chapal M, Néel M, Le Borgne F, Meffray E, Carceles O, Hourmant M, Giral M, Foucher Y, Moreau A, Fakhouri F (2013) Increased soluble flt-1 correlates with delayed graft function and early loss of peritubular capillaries in the kidney graft. Transplantation, 96(8): 739-44.
  
  
• Cantarovich D, Hodemon-Corne B, Trébern-Launay K, Giral M, Foucher Y, Dantan E (2013) Early steroid withdrawal compared with steroid avoidance correlates with graft failure among kidney transplant recipients with an history of diabetes. Transplantation Procedings, 45(4): 1497-502.
  
  
• Danger R, Paul C, Giral M, Foucher Y, Degauque N, Pallier A, Durand M, Castagnet S, Duong Van Huyen J, Delahousse M, Renaudin K, Soulillou JP, Brouard S (2013) Expression of miR-142-5p in peripheral blood mononuclear cells from renal transplant patients with chronic antibody-mediated rejection. PLoS One, 8(4): e60702.
  
  
• Thibaud A, Foucher Y, Danger R, Migone T, Pallier A, Castelli C, Castagnet S, Devys A, Cesbron A, Giral M, Soulillou JP, Brouard S (2012) BAFF and BAFF-R levels are associated with risk of long-term kidney graft dysfunction and development of donor-specific antibodies. Am J Transplant, 12(10): 2754-62.
  
  
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