A few simple questions can help patients and their doctors predict whether a kidney transplant from a deceased donor will succeed long-term, according to new research published in American Journal of Kidney Diseases, the official journal of the National Kidney Foundation
"Surprisingly few tools have been developed to predict outcomes after kidney transplant," Bertram L. Kasiske, MD, of Hennepin County Medical Center in Minneapolis, and his colleagues note in their report. Gauging how well a patient will fare after receiving a new kidney is important, they add, because then doctors can determine if a patient would be better off continuing dialysis. Such a tool can also help patients and their doctors determine whether a particular kidney is suitable, and if the transplant is performed how much medication the patient will need to prevent rejection.
Dr. Kasiske analyzed data on nearly 60,000 patients who received kidney transplants from a deceased donor between 2000 and 2006. He and his team looked at dozens of variables to identify which factors best predicted whether the donated kidney would still be functioning five years after transplant. Predictions were based on information available at three different points in time: before the transplant; seven days after the transplant surgery; and one year after the transplant. The first analysis included 59,091 patients, the second, 57,603 patients, and the third, 43,743 patients.
Eleven factors could be used, pre-transplant, to predict the likelihood that a transplant with a particular kidney would fail within five years: age of the donor, race of the recipient, whether or not this was the patient's first transplant, how many years the patient had been on dialysis, age of the patient, main cause of kidney disease, whether the patient had hepatitis C, whether the donor had high blood pressure, the type of health insurance the recipient had (patients on private insurance did better than patients on Medicare), and the number of tissue mismatches between donor and recipient.
Just eight factors measured a week after transplant could predict long-term outcome: the donated kidney's level of function at hospital discharge (using a measure known as glomerular filtration rate); age of the donor; main cause of kidney disease; race and age of the recipient; and how many years the recipient had been on dialysis. And at one year post-transplant, just six factors were needed to gauge the risk that a transplant would fail within five years: current function of the donated kidney; race of the recipient; whether or not the recipient had been hospitalized during the previous year; cause of kidney disease; recipient's age, and the type of insurance coverage the recipient had (again, privately insured patients did better than those on Medicare).
"We believe that this tool provides the best available information for predicting risk and that it may help clinicians make important decisions regarding selection of deceased donor kidneys and post-transplant management strategies," Dr. Kasiske and his team conclude.
"About half of the kidney transplants performed each year in the U.S. are from deceased donors," says Dr. Kerry Willis, a senior vice president at the National Kidney Foundation. "Time is of the essence in kidney transplantation, and the new prediction tools developed by Dr. Kasiske and his colleagues will help patients with kidney disease and their doctors quickly determine whether a particular donor organ is suitable for them. The tool helps make the most efficient use of available organs and can ultimately, increase the supply."
Dr. Willis noted that Dr. Kasiske and his team have made a Web-based calculator available, at www.txscores.org. "This can also help guide decisions on treating patients after transplant."