TY - JOUR
T1 - Dynamic predictions of long-term kidney graft failure
T2 - an information tool promoting patient-centred care
AU - Fournier, Marie-Cécile
AU - Foucher, Yohann
AU - Blanche, Paul
AU - Legendre, Christophe
AU - Girerd, Sophie
AU - Ladrière, Marc
AU - Morelon, Emmanuel
AU - Buron, Fanny
AU - Rostaing, Lionel
AU - Kamar, Nassim
AU - Mourad, Georges
AU - Garrigue, Valérie
AU - Couvrat-Desvergnes, Grégoire
AU - Giral, Magali
AU - Dantan, Etienne
AU - DIVAT Consortium
N1 - © The Author(s) 2019. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.
PY - 2019/11/1
Y1 - 2019/11/1
N2 - BACKGROUND: Informing kidney transplant recipients of their prognosis and disease progression is of primary importance in a patient-centred vision of care. By participating in decisions from the outset, transplant recipients may be more adherent to complex medical regimens due to their enhanced understanding.METHODS: We proposed to include repeated measurements of serum creatinine (SCr), in addition to baseline characteristics, in order to obtain dynamic predictions of the graft failure risk that could be updated continuously during patient follow-up. Adult recipients from the French Données Informatisées et VAlidées en Transplantation (DIVAT) cohort transplanted for the first or second time from a heart-beating or living donor and alive with a functioning graft at 1 year post-transplantation were included.RESULTS: The model was composed of six baseline parameters, in addition to the SCr evolution. We validated the dynamic predictions by evaluating both discrimination and calibration accuracy. The area under the receiver operating characteristic curve varied from 0.72 to 0.76 for prediction times at 1 and 6 years post-transplantation, respectively, while calibration plots showed correct accuracy. We also provided an online application tool (https://shiny.idbc.fr/DynPG).CONCLUSION: We have created a tool that, for the first time in kidney transplantation, predicts graft failure risk both at an individual patient level and dynamically. We believe that this tool would encourage willing patients into participative medicine.
AB - BACKGROUND: Informing kidney transplant recipients of their prognosis and disease progression is of primary importance in a patient-centred vision of care. By participating in decisions from the outset, transplant recipients may be more adherent to complex medical regimens due to their enhanced understanding.METHODS: We proposed to include repeated measurements of serum creatinine (SCr), in addition to baseline characteristics, in order to obtain dynamic predictions of the graft failure risk that could be updated continuously during patient follow-up. Adult recipients from the French Données Informatisées et VAlidées en Transplantation (DIVAT) cohort transplanted for the first or second time from a heart-beating or living donor and alive with a functioning graft at 1 year post-transplantation were included.RESULTS: The model was composed of six baseline parameters, in addition to the SCr evolution. We validated the dynamic predictions by evaluating both discrimination and calibration accuracy. The area under the receiver operating characteristic curve varied from 0.72 to 0.76 for prediction times at 1 and 6 years post-transplantation, respectively, while calibration plots showed correct accuracy. We also provided an online application tool (https://shiny.idbc.fr/DynPG).CONCLUSION: We have created a tool that, for the first time in kidney transplantation, predicts graft failure risk both at an individual patient level and dynamically. We believe that this tool would encourage willing patients into participative medicine.
U2 - 10.1093/ndt/gfz027
DO - 10.1093/ndt/gfz027
M3 - Journal article
C2 - 30859193
SN - 0931-0509
VL - 34
SP - 1961
EP - 1969
JO - Nephrology, Dialysis, Transplantation
JF - Nephrology, Dialysis, Transplantation
IS - 11
ER -