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Abstract: PO2579

Allograft Loss and Patient Death Among Kidney Transplant Recipients: Is Therapy Nonadherence the Underlying Perpetrator?

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Kalra, Kartik, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
  • Sood, Puneet, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
  • Mehta, Rajil B., University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
  • Puttarajappa, Chethan M., University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
  • Wu, Christine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
  • Hariharan, Sundaram, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
  • Shah, Nirav A., University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
Background

To ascertain causes of allograft dysfunction, loss and death in a cohort of kidney transplant patients

Methods

Retrospective cohort study, 943 patients with isolated Kidney transplants between years 2013-17 were analyzed for the following transplant outcomes: 1. Death-censored allograft loss 2. Graft dysfunction 3. Death.

Results

80 of 943 (9%) patients died while 63 (7%) lost their graft and 38 (4%) suffered allograft dysfunction. Death- Death was attributed to a combination of infection (29%), Cardiovascular (CV) disease (29%) and malignancy (12%), a significant proportion of patients who died from either CV disease (43%), infection (26%) or malignancy (20%) had prior biopsy proven T-Cell Mediated Rejection (TCMR) in 1st post-transplant year. Graft Loss- In this cohort TCMR (39%) was the most widespread factor contributing to allograft loss. While Infection (17%) and surgical causes (14%) were the next common associations, donor related disease accounted for 2% of graft losses. Graft Dysfunction- TCMR (42%) was strongly associated with allograft dysfunction in our patient cohort. The other factors associated with Allograft Dysfunction included a). Infection (21%) b). Donor Related causes (11%) and c).Other Causes (15%). Surprisingly ABMR was only noted in 11% of patients with allograft decline. Rejection and Non-Adherence- As TCMR was a common contributing factor to all the three hard outcomes in our study cohort, we examined the factors associated with TCMR. 40% of patients with TCMR were found to be non-adherent (defined by > 3 consecutive sub- therapeutic CNI levels, clinic no shows and poor adherence to regular lab draws). Importantly, patients who were non adherent were significantly younger (mean age 38 y vs 55 y; p=0.0001) and a greater proportion of them were of African American (47% vs 22%;p=0.055) compared to those who were adherent to therapy.

Conclusion

While the causes of death, early allograft loss and dysfunction were diverse, TCMR was the most dominant contributor. Non-Adherence was strongly associated with TCMR and was more common in younger patients and those with African American ethnicity. Addressing non adherence in this cohort of patients early with novel interventions could be a key to optimizing patient outcomes in this high risk cohort.