title: Use of 12-month renal function and baseline clinical factors to predict long-term graft survival: application to BENEFIT and BENEFIT-EXT trials.
abstract: BACKGROUND
  Innovation in renal transplant management would benefit from identification of early markers that accurately predict long-term graft survival.
  
  
  METHODS
  Data from the United States Renal Data System for kidney transplant recipients (1995-2004) were analyzed to develop prediction models for all-cause graft survival based on estimated glomerular filtration rate (eGFR), the presence or absence of acute rejection within 1 year, and recipient and donor demographic characteristics. The prediction models were applied to participants in the Belatacept Evaluation of Nephroprotection and Efficacy as First-line Immunosuppression Trial and Belatacept Evaluation of Nephroprotection and Efficacy as First-line Immunosuppression Trial--EXTended criteria donors trials comparing belatacept with cyclosporine in standard criteria donor (SCD) and expanded criteria donor (ECD) graft recipients, respectively, as an external validation of the model predictions in a diverse population.
  
  
  RESULTS
  Compared with eGFR 60 mL/min/1.73 m(2), the relative hazard for all-cause graft loss increased in an accelerating pattern with lower GFR to approximately eight and seven times, respectively, among SCD and ECD recipients with eGFR less than 15 mL/min/1.73 m(2). When applied to the clinical trial samples, the predicted differences in all-cause graft survival of less intensive belatacept versus cyclosporine at the second transplant anniversary (SCD: 3.9%, 95% confidence interval [CI]: 3.6% to 4.2%; ECD: 4.1%, 95% CI: 3.5% to 4.7%) were similar to observed differences (SCD: 4.2%, 97.3% CI: -1.3% to 10.1%; ECD: 1.4%, 97.3% CI: -7.5% to 10.2%).
  
  
  CONCLUSIONS
  Accurate models of long-term graft survival can be developed using eGFR, donor, and recipient characteristics. Long-term survival prediction models may provide an efficient method for assessing the impact of novel pharmaceutical agents and clinical management protocols.
authors.affiliation: Saint Louis University Center for Outcomes Research, St. Louis, MO 63104, USA.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Schnitzler
authors.forename: Krista L
authors.initials: KL
authors.lastname: Lentine
authors.forename: David
authors.initials: D
authors.lastname: Axelrod
authors.forename: Adrian
authors.initials: A
authors.lastname: Gheorghian
authors.forename: Min
authors.initials: M
authors.lastname: You
authors.forename: Anupama
authors.initials: A
authors.lastname: Kalsekar
authors.forename: Gilbert
authors.initials: G
authors.lastname: L'Italien
mesh_terms: D000069594:Abatacept; D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D016572:Cyclosporine / Q000627:therapeutic use; D016208:Databases, Factual; D005260:Female; D005919:Glomerular Filtration Rate; D006085:Graft Survival / Q000276:immunology / Q000502:physiology*; D006801:Humans; D018796:Immunoconjugates / Q000627:therapeutic use*; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007677:Kidney Function Tests; D016030:Kidney Transplantation / Q000276:immunology / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D013997:Time Factors; D014019:Tissue Donors; D009927:Tissue and Organ Procurement; D014481:United States; D055815:Young Adult
chemical_list: D018796:Immunoconjugates; D007166:Immunosuppressive Agents; D000069594:Abatacept; D016572:Cyclosporine