Predicting 2-Year Early Allograft Failure After Kidney Transplant: A Perioperative Risk Model from the MOVER Cohort

TL;DR

This study developed a risk model to predict early kidney transplant failure within 2 years based on factors like obesity and blood conditions.

Contribution

A new perioperative risk model for early allograft failure after kidney transplantation using the MOVER Cohort.

Findings

Obesity and thrombocytopenia were linked to increased allograft failure risk.

Anemia and preoperative clonidine use were associated with reduced risk.

The model identified distinct risk groups but had modest overall performance.

Abstract

Background: Allograft failure after kidney transplantation remains common despite improving long-term outcomes and persistent organ scarcity. We aimed to develop and internally validate a perioperative risk model for kidney allograft failure within 2 years of transplantation. Methods: We conducted a single-center retrospective cohort study using the Medical Informatics Operating Room Vitals and Events Repository. Adult patients (≥18 years) undergoing kidney transplantation between January 2018 and July 2023 with at least 2 years of follow-up were included. The primary outcome was allograft failure within 2 years, defined as return to dialysis, pre-emptive re-transplantation, or death. Candidate predictors included demographic characteristics, comorbidities, preoperative laboratory values, and intraoperative variables. After univariate screening and variable selection with LASSO-penalized regression, we estimated relative risks using modified Poisson regression and assessed internal validity with 200 bootstrap resamples. Results: Among 319 recipients, 53 (16.6%) experienced early allograft failure. In the final multivariable model, obesity (relative risk [RR] 4.76; bootstrap 95% CI 2.88–9.31) and thrombocytopenia (RR 1.96; bootstrap 95% CI 1.18–3.38) were independently associated with increased risk. Anemia (RR 0.22; bootstrap 95% CI 0.13–0.37), preoperative clonidine use (RR 0.33; bootstrap 95% CI 0.00–0.85), and female sex (RR 0.55; bootstrap 95% CI 0.26–0.83) were associated with reduced risk. Model performance was modest (pseudo-R2 0.21) but identified clinically distinct risk strata. Conclusions: A five-variable perioperative model based on obesity, thrombocytopenia, anemia, preoperative clonidine use, and female sex identified kidney transplant recipients at differing risk of allograft failure within 2 years. These associations highlight potentially modifiable targets that warrant further study and external validation before clinical use.

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