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  • Steven Skipper posted an update 1 year, 5 months ago

    ?2A�CC). In the group of proteinuria 3500?mg/L (N?=?6), the five-yr patient survival was 85.8%, 62.6%, 41.7%, and 80%, respectively (p?<?0.001), five-yr death-censored graft survival was 76.9%, 36.8%, 0%, and 50%, respectively (p?<?0.001), and the five-yr overall survival (including death) was 68.7%, 24.7%, 10.3%, and 41.7%, respectively (p?<?0.001). To systematically assess the relationship between proteinuria and survival, we performed a ROC curve analysis. The Selleck Venetoclax first ROC curve analysis for patient survival using quantitative value only showed an area under the curve (AUC) of 0.557, p?=?0.39, N?=?311. The second ROC curve analysis for patient survival using imputed values as well showed an AUC of 0.577, p?=?0.13, N?=?528. There was no significant impact on patient survival. We found a significant relationship between proteinuria at conversion and death-censored graft survival with an AUC of 0.728 (p?<?0.001, N?=?311, Fig.?3) and a cutoff value of 268?mg/L urinary protein (sensitivity 61.4%, specificity 83.9%, positive predictive value [PPV] 90.6%, and negative predictive value [NPV] 46.1%). Considering imputed values as well, the AUC was 0.71 (p?<?0.001, N?=?524) and the cutoff value was 151?mg/L (sensitivity 66.7%, specificity 72.9%, PPV 91.1%, NPV 34.4%, N?=?528). As shown in Fig.?4A, already modest proteinuria >268?mg/L had a strong impact on graft failure. The five-yr death-censored graft survival was 79.7% in patients below and 34.8% in patients above the cutoff value of 268?mg/L. Using imputed values for the cutoff value of 151?mg/L, five-yr death-censored graft survival was 81.1% (151?mg/L), respectively (p?<?0.001, Fig.?4B). When performing a ROC curve analysis for overall survival (including death), we found a cutoff of 151 mg/L (p < 0.001, AUC 0.699, sensitivity 67.1%, specificity 72.3%, PPV 87.8%, NPV 42.6%, N = 311). The overall five-yr overall survival (including death) was 72.3% vs. 33.6% (p < 0.001, Fig.?5A). The same cutoff was calculated in the second ROC curve analysis using imputed values (AUC 0.692, p < 0.001, sensitivity 61.8%, specificity 74.3%, PPV 86.5%, NPV 42.2%, N = 528). The overall five-yr overall survival (including death) was 72.7% vs. 33.7% (p < 0.001, Fig.?5B) for this imputed cutoff. Lastly, we performed a Cox proportional hazard analysis on overall survival (including death) (Table?2). There was a 1.556-fold (CI: 1.252�C1.934, p?<?0.001) higher risk of graft loss or death per 1000?mg/L urinary protein concentration at conversion. Similarly, creatinine at conversion was associated with an increasing risk of 2.898 per mg/dL (CI: 2.233�C3.761, p?<?0.001). As expected, age at transplantation increased the risk of graft loss and death (HR 1.031 per year; CI: 1.010�C1.053, p?=?0.004).