Kidney Week

Abstract: PO2591

Who Is at Risk for a Transplant Nephrectomy After Graft Loss?

Session Information

• Transplant Complications: Glomerular Disease and Genetics
  October 22, 2020 | Location: On-Demand
  Abstract Time: 10:00 AM - 12:00 PM

Category: Transplantation

• 1902 Transplantation: Clinical

Authors

• Thorne, Peter E., Vanderbilt University Medical Center, Nashville, Tennessee, United States

Peter E. Thorne,

• Ramos, Everly, Vanderbilt University Medical Center, Nashville, Tennessee, United States

Everly Ramos,

• Binari, Laura, Vanderbilt University Medical Center, Nashville, Tennessee, United States

Laura Binari,

• Kochar, Guneet S., Vanderbilt University Medical Center, Nashville, Tennessee, United States

Guneet S. Kochar,

• Stewart, Thomas G., Vanderbilt University Medical Center, Nashville, Tennessee, United States

Thomas G. Stewart,

• Forbes, Rachel C., Vanderbilt University Medical Center, Nashville, Tennessee, United States

Rachel C. Forbes,

• Shawar, Saed, Vanderbilt University Medical Center, Nashville, Tennessee, United States

Saed Shawar,

• Langone, Anthony J., Vanderbilt University Medical Center, Nashville, Tennessee, United States

Anthony J. Langone,

• Abdel-Kader, Khaled, Vanderbilt University Medical Center, Nashville, Tennessee, United States

Khaled Abdel-Kader,

• Concepcion, Beatrice P., Vanderbilt University Medical Center, Nashville, Tennessee, United States

Beatrice P. Concepcion,

Background

Patients with failed kidney transplants who subsequently develop clinical symptoms such as fever, allograft pain and gross hematuria usually require a transplant nephrectomy to alleviate symptoms. Identifying patients at risk for a nephrectomy after graft loss may aid clinical decision-making and care at time of, and after graft loss.

Methods

We retrospectively reviewed all patients with death-censored graft loss (DCGL) from 1/2000 to 6/2018 at a single center. We collected baseline demographic and clinical characteristics at time of transplant, at time of, and after DCGL by manual chart abstraction. Data were analyzed using summary statistics. Predictors for nephrectomy were determined a priori. A Cox proportional hazards model was used to quantify the association of age, race, gender, body mass index (BMI) at time of graft loss, diabetes, acute rejection as cause of graft loss, and use of prednisone with the risk of nephrectomy.

Results

The study included 333 patients with DCGL of whom 75 (23%) underwent a transplant nephrectomy. Median (IQR) time from graft loss to nephrectomy was 135 (70, 267) days. Among 292 patients without missing data, baseline and transplant characteristics were as follows: age at transplantation 45 (36, 57), 59% male, 40% black, 20% diabetic, 53% with a deceased donor, 83% on calcineurin-based immunosuppression (CNI-IS), 71% on prednisone. Twenty four percent and 69% of patients lost their graft due to acute rejection and chronic allograft nephropathy, respectively. At the time of DCGL: BMI was 25.9 kg/m² (22.7, 31.4), SCr 7.5 mg/dl (5.6, 9.6), albumin 3.3 (3.0, 3.8), 86% on CNI-IS, 91% on prednisone. In the Cox model, black race was associated with more than twice greater risk of nephrectomy compared to non-blacks (HR 2.4, 95% CI 1.3-4.3, p=<0.01). Older age had a trend for decreased risk of nephrectomy (HR 0.98, 95% CI 0.95-1.0, p=0.06) but this did not reach statistical significance.

Conclusion

Transplant nephrectomies are common after graft loss and black race is associated with increased risk. Closer monitoring of these patients after graft loss may be warranted. Strategies and interventions to reduce the need for nephrectomy warrant further study.