title: Development and validation of a prognostic index for allograft outcome in kidney recipients with transplant glomerulopathy.
abstract: We studied 92 patients with transplant glomerulopathy to develop a prognostic index based on the risk factors for allograft failure within five years of diagnosis (Development cohort). During 60 months (median) follow-up, 64 patients developed allograft failure. A chronic-inflammation score generated by combining Banff ci, ct and ti scores, serum creatinine and proteinuria at biopsy, were independent risk factors for allograft failure. Based on the Cox model, we developed a prognostic index and classified patients into risk groups. Compared to the low-risk group (median allograft survival over 60 months from diagnosis), patients in the medium risk group had a hazard ratio of 2.83 (median survival 25 months), while those in the high-risk group had a hazard ratio of 5.96 (median survival 3.7 months). We next evaluated the performance of the prognostic index in an independent external cohort of 47 patients with transplant glomerulopathy (Validation cohort). The hazard ratios were 2.18 (median survival 19 months) and 16.27 (median survival 1.6 months), respectively, for patients in the medium and high-risk groups, compared to the low-risk group (median survival 47 months). Our prognostic index model did well in measures of discrimination and calibration. Thus, risk stratification of transplant glomerulopathy based on our prognostic index may provide informative insight for both the patient and physician regarding prognosis and treatment.
authors.forename: Pallavi
authors.initials: P
authors.lastname: Patri
authors.forename: Surya V
authors.initials: SV
authors.lastname: Seshan
authors.forename: Marie
authors.initials: M
authors.lastname: Matignon
authors.forename: Dominique
authors.initials: D
authors.lastname: Desvaux
authors.forename: John R
authors.initials: JR
authors.lastname: Lee
authors.forename: Jun
authors.initials: J
authors.lastname: Lee
authors.forename: Darshana M
authors.initials: DM
authors.lastname: Dadhania
authors.forename: David
authors.initials: D
authors.lastname: Serur
authors.forename: Philippe
authors.initials: P
authors.lastname: Grimbert
authors.forename: Choli
authors.initials: C
authors.lastname: Hartono
authors.forename: Thangamani
authors.initials: T
authors.lastname: Muthukumar
mesh_terms: D000328:Adult; D005260:Female; D006085:Graft Survival; D006801:Humans; D007674:Kidney Diseases; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012720:Severity of Illness Index