Avaliação da associação entre Kidney Donor Profile Index, desfechos clínicos e terapia imunossupressora em receptores de transplante renal de doador falecido
Data
2021-10-01
Autores
Foresto, Renato Demarchi 
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Introdução: O impacto do KDPI na taxa de filtração glomerular estimada (TFGe)
após 1 ano do transplante, bem como em outros desfechos do transplante renal
precisam ser mais bem elucidados na população brasileira. Ainda, não há dados sobre
qual terapia imunossupressora melhor se adaptaria aos rins com KDPI elevado.
Objetivo: Avaliar o impacto do escore KDPI nos desfechos clínicos ao final de 12
meses após o transplante renal. Metodologia: Estudo do tipo coorte histórica, de
centro único, com análise de 3.059 transplantes renais de doador falecido realizados
entre 2013 e 2017, com seguimento por 12 meses. Os pacientes foram divididos em
4 grupos, conforme faixas de KDPI (0-35%; 36-50%; 51-85%; 86-100%). Foi utilizado
o modelo de regressão logística para análise dos preditores para TFGe <50
ml/min/1,73m2 ao final de 1 ano. O cálculo da TFGe foi feito através da equação CKDEPI.
Os desfechos clínicos ao final de 1 ano considerados foram: TFGe, infecção por
CMV, rejeição aguda, perda do enxerto e óbito. Foi realizada uma subanálise no grupo
KDPI >85% comparando os mesmos desfechos entre 3 grupos conforme o regime
imunossupressor: micofenolato vs. azatioprina vs. inibidor da mTOR (imTOR).
Resultados: A TFGe reduziu conforme aumento do KDPI (64,8 vs. 53,5 vs. 46,9 vs.
39,1 ml/min/1,73m2; p<0,001). Na análise multivariada, os preditores de TFGe <50
ml/min/1,73m2 foram KDPI >35%, tempo de isquemia fria (OR=1,015; IC95% 1,003-
1,027; p=0,012), infecção por CMV (OR=1,214; IC95% 1,037-1,420; p=0,016) e
rejeição aguda (OR=2,411; IC95% 1,942-2,993; p<0,001). Na subanálise do regime
imunossupressor nos receptores de rins com KDPI >85%, a incidência de infecção por
CMV foi menor no grupo imTOR (64,5% vs. 36,0% vs. 8,2%; p<0,001). Porém,
comparado ao MPS, o uso de imTOR foi associado a menor TFGe (39,8 vs. 39,5 vs.
28,3 ml/min/1,73m2; p=0,009) e maior incidência de rejeição aguda (15,8% vs. 50,0%
vs. 23,3%; p<0,001). Conclusão: O escore KDPI apresentou capacidade em predizer
o desfecho de TFGe ao final de 1 ano. O regime imunossupressor contendo imTOR
deve ser utilizado com cautela nos receptores de rins com KDPI >85%.
Introduction: The impact of KDPI on the estimated glomerular filtration rate (eGFR) 1 year after transplantation and other outcomes of kidney transplantation needs to be better elucidated in the Brazilian population. Still, there is no data on which immunosuppressive therapy would best suit kidneys with high KDPI. Objective: To assess the association of the KDPI on 1-year clinical outcomes after kidney transplantation. Methods: This single-center, historical cohort study analyzed 3,059 kidney transplants from deceased donors performed between 2013 and 2017, with a 12-month follow-up. Patients were divided into 4 groups, according to KDPI ranges (0- 35%; 36-50%; 51-85%; 86-100%). The logistic regression model was used to analyze the predictors for eGFR <50 ml/min/1.73m2 at the end of 1 year. Calculation of eGFR was performed using the CKD-EPI equation. The 1-year clinical outcomes were: eGFR, CMV infection, acute rejection, graft loss, and death. A sub-analysis was performed in the group KDPI >85%, comparing the same outcomes between 3 groups according to the immunosuppressive regimen: mycophenolate vs. azathioprine vs. mTOR inhibitor (imTOR). Results: eGFR decreased as KDPI increased (64.8 vs. 53.5 vs. 46.9 vs. 39.1 ml/min/1.73m2 ; p<0.001). In the multivariate analysis, the predictors of eGFR <50 ml/min/1.73m2 were KDPI >35%, cold ischemia time (OR=1.015; 95%CI 1.003-1.027; p=0.012), CMV infection (OR=1.214; 95%CI 1.037-1.420; p=0.016) and acute rejection (OR=2.411; 95%CI 1.942-2.993; p<0.001). In the subanalysis of the immunosuppressive regimen in recipients with KDPI >85%, the incidence of CMV infection was lower in the imTOR group (64.5% vs. 36.0% vs. 8.2%; p<0.001). However, compared to MPS, the use of imTOR was associated with lower eGFR (39.8 vs. 39.5 vs. 28.3 ml/min/1.73m2 ; p=0.009) and a higher incidence of acute rejection (15.8% vs. 50.0% vs. 23.3%; p<0.001). Conclusion: The KDPI was able to predict the outcome of eGFR at the end of 1 year. ImTOR-containing immunosuppressive regimen should be used with caution in kidney recipients with KDPI >85%.
Introduction: The impact of KDPI on the estimated glomerular filtration rate (eGFR) 1 year after transplantation and other outcomes of kidney transplantation needs to be better elucidated in the Brazilian population. Still, there is no data on which immunosuppressive therapy would best suit kidneys with high KDPI. Objective: To assess the association of the KDPI on 1-year clinical outcomes after kidney transplantation. Methods: This single-center, historical cohort study analyzed 3,059 kidney transplants from deceased donors performed between 2013 and 2017, with a 12-month follow-up. Patients were divided into 4 groups, according to KDPI ranges (0- 35%; 36-50%; 51-85%; 86-100%). The logistic regression model was used to analyze the predictors for eGFR <50 ml/min/1.73m2 at the end of 1 year. Calculation of eGFR was performed using the CKD-EPI equation. The 1-year clinical outcomes were: eGFR, CMV infection, acute rejection, graft loss, and death. A sub-analysis was performed in the group KDPI >85%, comparing the same outcomes between 3 groups according to the immunosuppressive regimen: mycophenolate vs. azathioprine vs. mTOR inhibitor (imTOR). Results: eGFR decreased as KDPI increased (64.8 vs. 53.5 vs. 46.9 vs. 39.1 ml/min/1.73m2 ; p<0.001). In the multivariate analysis, the predictors of eGFR <50 ml/min/1.73m2 were KDPI >35%, cold ischemia time (OR=1.015; 95%CI 1.003-1.027; p=0.012), CMV infection (OR=1.214; 95%CI 1.037-1.420; p=0.016) and acute rejection (OR=2.411; 95%CI 1.942-2.993; p<0.001). In the subanalysis of the immunosuppressive regimen in recipients with KDPI >85%, the incidence of CMV infection was lower in the imTOR group (64.5% vs. 36.0% vs. 8.2%; p<0.001). However, compared to MPS, the use of imTOR was associated with lower eGFR (39.8 vs. 39.5 vs. 28.3 ml/min/1.73m2 ; p=0.009) and a higher incidence of acute rejection (15.8% vs. 50.0% vs. 23.3%; p<0.001). Conclusion: The KDPI was able to predict the outcome of eGFR at the end of 1 year. ImTOR-containing immunosuppressive regimen should be used with caution in kidney recipients with KDPI >85%.