Early Post-Transplant Renal Recovery Trajectory and Trajectory Velocity Functions Are Predictors of Estimated GFR at 1 Year: A Functional Data Analysis Approach

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation Pub Date : 2025-03-06 DOI:10.1111/ctr.70119

Wairimu Magua, Octav Cristea, Emily M. Eichenberger, Geeta M. Karadkhele, Alanna A. Morris, Kenneth Newell, Joseph B. Rickert, Christian P. Larsen

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引用次数: 0

Abstract

Introduction

Kidney function at 1-year post-transplant is an indicator of long-term graft function. Using functional data analysis (FDA), we evaluate the relationship between early renal recovery trajectories and kidney function at 1 year.

Methods

We analyzed 1748 adults who underwent deceased-donor kidney transplantation between 2010 and 2021. Renal recovery trajectory functions were derived from longitudinal inverse creatinine values. Functional linear regression models were used to evaluate how well early (<90 days) renal recovery trajectory functions, and their rate of change explained 1-year eGFR. The explanatory power of the functional regression models was compared to results from ordinary least squares models, which used cross-sectional inverse creatinine values and linear slopes. Models were adjusted for age, sex, kidney donor profile index (KDPI), delayed graft function (DGF), race, body mass index (BMI), rejection, diabetes, hypertension, cytomegalovirus (CMV) serostatus risk, index admission length of stay, and immunosuppression agent. The R² coefficient quantified the 1-year eGFR variation explained by model variables.

Results

Adjusted functional linear models with renal recovery trajectory and trajectory velocity functions as independent variables explained 68% (65, 71), 70% (67, 74), 70% (66, 74), 70% (66, 75), and 73% (69, 79) of the variation in 1-year eGFR by 7, 14, 30, 60, and 90 days, respectively. By comparison, the ordinary least squares linear models explained a maximum of 69% of the variation in 1-year eGFR at 90 days.

Conclusion

Renal recovery patterns captured as continuous functions as early as 14 days are predictive of renal function at 1 year and may enable early personalized care of recipients at increased risk of poor graft function.

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移植后早期肾脏恢复轨迹和轨迹速度函数是1年估计GFR的预测因子：一种功能数据分析方法

移植后1年的肾功能是长期移植功能的指标。使用功能数据分析（FDA），我们评估了1年后早期肾脏恢复轨迹与肾功能之间的关系。方法：我们分析了2010年至2021年间1748例接受了已故供体肾移植的成年人。肾脏恢复轨迹函数由纵向逆肌酐值推导。使用功能线性回归模型来评估早期（90天）肾脏恢复轨迹功能的良好程度，其变化率解释了1年的eGFR。将功能回归模型的解释能力与使用横截面反肌酸酐值和线性斜率的普通最小二乘模型的结果进行比较。根据年龄、性别、肾脏供者概况指数（KDPI）、移植延迟功能（DGF）、种族、体重指数（BMI）、排斥反应、糖尿病、高血压、巨细胞病毒（CMV）血清状态风险、指数住院时间和免疫抑制剂对模型进行调整。R2系数量化了模型变量解释的1年eGFR变化。结果以肾脏恢复轨迹和轨迹速度函数为自变量的调整功能线性模型分别解释了7、14、30、60和90天1年eGFR变化的68%（65,71）、70%（67,74）、70%（66,74）、70%（66,75）和73%（69,79）。相比之下，普通最小二乘线性模型解释了90天1年eGFR变化的69%。结论早在14天的肾脏恢复模式可预测1年的肾功能，并可使移植肾功能不良风险增加的受者早期个性化护理成为可能。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Transplantation 医学-外科

CiteScore

3.70

自引率

4.80%

发文量

286

审稿时长

2 months

期刊介绍： Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored. Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include: Immunology and immunosuppression; Patient preparation; Social, ethical, and psychological issues; Complications, short- and long-term results; Artificial organs; Donation and preservation of organ and tissue; Translational studies; Advances in tissue typing; Updates on transplant pathology;. Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries. Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.