Journal Information
Vol. 33. Issue 4.
Pages 194-201 (January 2009)
Vol. 33. Issue 4.
Pages 194-201 (January 2009)
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Predicting risk of acute rejection in patients with kidney transplants
Predicción de riesgo de rechazo agudo en pacientes con trasplante renal
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M.A. López-Montenegro Soria, B. Porta Oltra
Corresponding author
porta_beg@gva.es

Corresponding author.
, N.V. Jiménez Torres, L. Pallardó Mateu
Servicio de Farmacia, Hospital Universitario Doctor Peset, Valencia, Spain
Departamento de Farmacia y Tecnología Farmacéutica, Facultad de Farmacia, Universidad de Valencia, Valencia, Spain
Servicio de Nefrología, Hospital Universitario Doctor Peset, Valencia, Spain
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Abstract
Objective

Create a model to predict the risk of acute rejection of kidney transplant considering variables related to the immunosuppressant agent used, the receiver, the donor, and the transplanted organ.

Methods

Cohort study in a population of 68 patients with kidney transplants being treated with tacrolimus triple therapy. Predicting the risk of acute rejection was carried out with a logistic regression analysis using age, sex, retransplant status, number of HLA incompatibilities, cold ischaemia time, acute tubular necrosis, induction with basiliximab or thymoglobulin, and treatment type as explanatory variables. The contribution of variables associated with determining the blood concentration of tacrolimus was also evaluated; these variables include the average blood concentration, the number of values below and included in the pre-defined therapeutic interval, and the time during which those values remained within that interval.

Results

The logistic regression analysis indicates that the risk of acute rejection depends on the acute tubular necrosis (OR=3; 95% CI, 0.7–13.2) and on the time that the blood concentrations of tacrolimus remains within the therapeutic interval (OR=0.8; 95% CI, 0.7–0.9).

The final model presents an optimal discrimination power (AUCROC=77%; 95% CI, 62–92). For the selected cut-off point (probability #>0.24) the model shows a sensitivity of 83% (95% CI, 74–90) and a specificity of 71% (95% CI, 61–80).

Conclusions

In patients with kidney transplants, the presence of acute tubular necrosis, together with the time the blood concentration of tacrolimus remained within the predetermined therapeutic interval, permitted the identification of patients with a higher probability of having an acute rejection episode during the first two weeks following the transplant.

Keywords:
Kidney transplant
Acute rejection
Tacrolimus
Blood concentration
Resumen
Objetivo

Construir un modelo para predecir el riesgo de rechazo agudo al trasplante renal considerando variables relacionadas con el tratamiento inmunosupresor instaurado, el receptor, el donante y el órgano trasplantado.

Método

Estudio de cohortes en una población de 68 pacientes con trasplante renal en tratamiento con tacrolimus en triple terapia. La predicción del riesgo de rechazo agudo se realizó mediante un análisis de regresión logística utilizando como variables explicativas la edad, sexo, presencia de retrasplante, número de incompatibilidades HLA, tiempo de isquemia fría, necrosis tubular aguda, inducción con basiliximab o timoglobulina y tipo de tratamiento. También se evaluó la contribución de variables asociadas a la determinación de la concentración sanguínea de tacrolimus, entre ellas la media de la concentración sanguínea, el número de valores por debajo e incluidos en el intervalo terapéutico predefinido, y el tiempo que dichos valores permanecían en las condiciones referidas.

Resultados

El análisis de regresión logística indica que el riesgo de rechazo agudo depende de la necrosis tubular aguda (odds ratio [OR] = 3; intervalo de confianza [IC] del 95 %, 0,7 a 13,2) y del tiempo que las concentraciones sanguíneas de tacrolimus permanecen dentro del intervalo terapéutico (OR = 0,8; IC del 95 %, 0,7 a 0,9).

El modelo final presenta un poder de discriminación óptimo (AUCROC: 77%; IC del 95%, 62 a 92%). Para el punto de corte seleccionado (probabilidad igual o superior a 0,24) el modelo presenta una sensibilidad del 83% (IC del 95%, 74 a 90%) y una especificidad del 71% (IC del 95%, 61 a 80%).

Conclusiones

En pacientes con trasplante renal, la presencia de necrosis tubular aguda junto al tiempo de permanencia de las concentraciones sanguíneas en el intervalo terapéutico de tacrolimus predeterminado, permiten la identificación de pacientes con mayor probabilidad de aparición de un episodio de rechazo agudo durante las primeras 2 semanas postrasplante.

Palabras clave:
Trasplante renal
Rechazo agudo
Tacrolimus
Concentración sanguínea
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