Comparing the prognostic performance of iBOX and biopsy-proven acute rejection for long-term kidney graft survival

Transplant Therapeutics Consortium, Amanda Klein, Luke Kosinski, Alexandre Loupy, Eric Frey, Mark Stegall, Ilkka Helanterä, Kenneth Newell, Herwig Ulf Meier-Kriesche, Roslyn B. Mannon, William E. Fitzsimmons

Forskningsoutput: TidskriftsbidragArtikelVetenskapligPeer review

Sammanfattning

Biopsy-proven acute rejection (BPAR) occurs in approximately 10% of kidney transplant recipients in the first year, making superiority trials unfeasible. iBOX, a quantitative composite of estimated glomerular filtration rate, proteinuria, antihuman leukocyte antigen donor-specific antibody, and + full/− abbreviated kidney histopathology, is a new proposed surrogate endpoint. BPAR's prognostic ability was compared with iBOX in a pooled cohort of 1534 kidney transplant recipients from 4 data sets, including 2 prospective randomized controlled trials. Discrimination analyses showed mean c-statistic differences between both iBOX compared with BPAR of 0.25 (95% confidence interval: 0.17-0.32) for full iBOX and 0.24 (95% confidence interval: 0.16-0.32) for abbreviated iBOX, indicating statistically significantly higher c-statistic values for the iBOX prognosis of death-censored graft survival. Mean (± standard error) c-statistics were 0.81 ± 0.03 for full iBOX, 0.80 ± 0.03 for abbreviated iBOX, and 0.57 ± 0.03 for BPAR. In calibration analyses, predicted graft loss events from both iBOX models were not significantly different from those observed. However, for BPAR, the predicted events were significantly (P <.01) different (observed: 64; predicted: 70; full iBOX: 76; abbreviated iBOX: 173 BPAR). IBOX at 1-year posttransplant is superior to BPAR in the first year posttransplant in graft loss prognostic performance, providing valuable additional information and facilitating the demonstration of superiority of novel immunosuppressive regimens.

Originalspråkengelska
TidskriftAmerican Journal of Transplantation
Volym24
Nummer10
Sidor (från-till)1784-1793
Antal sidor10
ISSN1600-6135
DOI
StatusPublicerad - okt. 2024
MoE-publikationstypA1 Tidskriftsartikel-refererad

Bibliografisk information

Publisher Copyright:
© 2024 American Society of Transplantation & American Society of Transplant Surgeons

Vetenskapsgrenar

  • 3126 Kirurgi, anestesiologi, intensivvård, radiologi

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