Purpose:

To develop a novel score for predicting mortality and graft failure after kidney transplant.

Methods:

We reviewed a cohort of 783 kidney transplant recipients and analyzed pertinent cardiovascular risk factors at the time of transplant evaluation to determine the risk of all-cause mortality and graft failure. The cardiac troponin T cut-off with the highest sensitivity and specificity for the outcomes was identified. The risk assigned to each predictor was determined by proportional hazards regression analysis with bootstrapping method.

Results:

The cohort (N=783) had a mean age of 58.7 years (SD 12.1) and median follow-up of 6.5 years (range 1 day to 18.0 years). Patients had high baseline cardiac and vascular disease (43% and 53%, respectively). 54% of patients (N=425) had serum troponin measured (median 0.02 ng/mL, range 0.01 to 4.91). We derived the ACTV score (age, cardiac disease, elevated troponin, and vascular disease) as a predictor of mortality and graft failure after kidney transplant: age 60 to 69 (1 point), age ≥70 years (2 points), cardiac disease (coronary artery disease or congestive heart failure; 1 point), troponin ≥0.04 ng/mL (1 point), and vascular disease (peripheral arterial disease, abdominal aortic aneurysm, cerebral vascular accident, or transient ischemic attack; 1 point).

The ACTV score was significantly predictive of death and graft failure. Substantial incremental risk was appreciated with each score level (0 to 2, 3 to 4, and 5 points).

Conclusions:

The ACTV score is a practical clinical tool that incorporates both clinical and biomarker data for prediction of mortality and graft failure after kidney transplant. Future studies are needed for validation in larger and more diverse populations.

CITATION INFORMATION: Parsons C., Shamoun F., Patel S., Cha S., Heilman R., Keddis M. A Novel Score for Predicting Mortality and Graft Failure after Kidney Transplant Am J Transplant. 2017;17 (suppl 3).

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