Kidney Week

Abstract: TH-OR126

Risk Prediction Score for Allograft Loss in Kidney Transplant Recipients: An International Derivation and Validation Study

Session Information

• Predictors of Clinical Outcomes After Kidney Transplantation
  October 25, 2018 | Location: 6C, San Diego Convention Center
  Abstract Time: 05:30 PM - 05:42 PM

Category: Transplantation

• 1802 Transplantation: Clinical

Authors

• Loupy, Alexandre, Paris Translational Research Center for Organ Transplantation, Paris, France

Alexandre Loupy

• Aubert, Olivier, Paris Translational Research Center for Organ Transplantation, Paris, France

Olivier Aubert,

• Bouatou, Yassine R., Paris Translational Research Center for Organ Transplantation, Paris, France

Yassine R. Bouatou,

• Viglietti, Denis, Paris Translational Research Center for Organ Transplantation, Paris, France

Denis Viglietti,

• Lefaucheur, Carmen, Paris Translational Research Center for Organ Transplantation, Paris, France

Carmen Lefaucheur,

Background

The field of kidney transplantation currently lacks robust models to predict long-term allograft failure, hampering patient care improvement and novel clinical trials. We aimed at developing and validating a score that predicts individual patients' risks of long-term kidney allograft failure.

Methods

This prospective international cohort study included consecutive kidney transplant recipients from a derivation cohort (n=4,000) recruited between 2005 and 2014 in four centres and a validation cohort of 3,557 kidney transplant recipients from six centres recruited in Europe (n=2,129) and North America (n=1,428) between 2002 and 2014. Thirty-three candidate prognostic factors of kidney allograft were assessed. The outcome was the long-term allograft failure (i.e. return on dialysis or pre-emptive re-transplantation); NCT03474003.

Results

Amongst the 7,557 patients included, 1,067 allograft failures occurred (14.12%) after a median follow-up time post-transplantation of 7.12 years (IQR: 3.51-8.77). In the derivation cohort, eight functional, histological and immunological prognostic factors were independently associated with allograft failure and were then combined into an integrative risk prediction score (iBox). This score exhibited accurate calibration and discrimination (C index=0.81; 95% CI, 0.79-0.83). The performance of the iBox was also confirmed in two validation cohorts from Europe (C-index=0.80; 95% CI=0.78-0.84) and the USA (C-index=0.80; 95% CI=0.76-0.84). The iBox was accurate at different times of posttransplant risk evaluation and outperformed conventional prediction model based on functional parameter assessment only. Finally, the performance of the iBox was confirmed in 3 independent randomised controlled therapeutic trials covering distinct clinical scenarios (C-index 0.87; 95% CI=0.82-0.92).

Conclusion

We developed the iBox risk prediction score, which accurately predicts kidney allograft failure and demonstrates generalisability across centres worldwide. This risk prediction score provides an accurate but simple strategy that can be easily implemented to stratify patients into clinically meaningful risk groups, which may help guide patient monitoring in everyday practice and improve the design of future clinical trials.