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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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.