Differences between Kidney Transplant Recipients from Deceased Donors with Diabetes Mellitus as Identified by Machine Learning Consensus Clustering
Abstract
:1. Introduction
2. Materials and Methods
2.1. Data Source and Study Population
2.2. Data Collection
2.3. Clustering Analysis
2.4. Outcomes
2.5. Statistical Analysis
3. Results
3.1. Clinical Characteristics of Each Cluster of Kidney Transplant Recipients from Diabetic Donors
3.2. Post-Transplant Outcomes of Each Cluster of Kidney Transplant Recipients from Diabetic Donors
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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All (n = 7876) | Cluster 1 (n = 2903) | Cluster 2 (n = 687) | Cluster 3 (n = 4286) | p-Value | |
---|---|---|---|---|---|
Recipient Age (year) | 58 ± 12 | 64 ± 8 | 49 ± 13 | 55 ± 12 | <0.001 |
Recipient male sex | 4955 (63) | 1992 (69) | 408 (59) | 2555 (60) | <0.001 |
Recipient race
| 0.001 | ||||
3187 (40) | 1114 (38) | 325 (47) | 1748 (41) | ||
2579 (33) | 952 (33) | 210 (31) | 1417 (33) | ||
1395 (18) | 547 (19) | 100 (15) | 748 (17) | ||
715 (9) | 290 (10) | 52 (8) | 373 (9) | ||
Body mass index (kg/m2) | 28.7 ± 5.2 | 28.6 ± 4.9 | 26.9 ± 5.1 | 29.0 ± 5.4 | <0.001 |
Kidney re-transplant | 702 (9) | 15 (1) | 687 (100) | 0 (0) | <0.001 |
Dialysis duration
| <0.001 | ||||
744 (9) | 257 (9) | 68 (10) | 419 (10) | ||
633 (8) | 263 (9) | 65 (9) | 305 (7) | ||
1800 (23) | 717 (25) | 178 (26) | 905 (21) | ||
4699 (60) | 1666 (57) | 376 (55) | 2657 (62) | ||
Cause of end-stage kidney disease
| <0.001 | ||||
2656 (34) | 1319 (45) | 27 (4) | 1310 (31) | ||
2121 (27) | 816 (28) | 72 (10) | 1233 (29) | ||
1208 (15) | 305 (11) | 114 (17) | 789 (18) | ||
6626 (8) | 201 (7) | 24 (3) | 401 (9) | ||
1265 (16) | 262 (9) | 450 (66) | 553 (13) | ||
Comorbidity
| |||||
3348 (43) | 1586 (55) | 147 (21) | 1615 (38) | <0.001 | |
718 (9) | 306 (11) | 66 (10) | 346 (8) | 0.002 | |
790 (10) | 379 (13) | 45 (7) | 366 (9) | <0.001 | |
PRA, median (IQR) | 0 (0, 24) | 0 (0, 0) | 88 (46, 98) | 0 (0, 25) | <0.001 |
Positive HCV serostatus | 341 (4) | 110 (4) | 27 (4) | 204 (5) | 0.12 |
Positive HBs antigen | 147 (2) | 51 (2) | 11 (2) | 85 (2) | 0.68 |
Positive HIV serostatus | 69 (1) | 8 (0.3) | 1 (0.2) | 60 (1) | <0.001 |
Functional status
| 0.03 | ||||
21 (0.3) | 11 (0.4) | 0 (0) | 10 (0.2) | ||
3326 (42) | 1249 (43) | 257 (37) | 1820 (42) | ||
4529 (58) | 1643 (57) | 430 (63) | 2456 (57) | ||
Working income | 1821 (23) | 477 (16) | 220 (32) | 1124 (26) | <0.001 |
Public insurance | 6272 (80) | 2353 (81) | 547 (80) | 3372 (79) | 0.049 |
US resident | 7834 (99) | 2890 (100) | 684 (100) | 4260 (99) | 0.62 |
Undergraduate education or above | 3888 (49) | 1375 (47) | 351 (51) | 2162 (50) | 0.02 |
Serum albumin (g/dL) | 4.0 ± 0.6 | 4.0 ± 0.6 | 3.9 ± 0.6 | 4.0 ± 0.6 | 0.001 |
Kidney donor status
| <0.001 | ||||
5413 (69) | 630 (22) | 603 (88) | 4180 (98) | ||
2463 (31) | 2273 (78) | 84 (12) | 106 (2) | ||
Donor age | 48 ± 12 | 58 ± 6.3 | 44 ± 11 | 42 ± 11 | <0.001 |
Donor male sex | 4296 (55) | 1553 (54) | 382 (56) | 2361 (55) | 0.35 |
Donor race
| <0.001 | ||||
4846 (62) | 1493 (51) | 438 (64) | 2915 (68) | ||
1246 (16) | 686 (24) | 88 (13) | 472 (11) | ||
1373 (17) | 542 (19) | 130 (19) | 701 (16) | ||
411 (5) | 182 (6) | 31 (5) | 198 (5) | ||
Donor weight (kg) | 94 ± 26 | 92 ± 23 | 95 ± 28 | 95 ± 27 | <0.001 |
Donor height (cm) | 170 ± 11 | 169 ± 11 | 170 ± 11 | 170 ± 12 | <0.001 |
Donor hypertension | 5414 (69) | 2590 (89) | 406 (59) | 2418 (56) | <0.001 |
Donor positive HCV serostatus | 147 (2) | 46 (2) | 8 (1) | 93 (2) | 0.07 |
Donor cerebrovascular death | 3100 (39) | 1828 (63) | 210 (31) | 1062 (25) | <0.001 |
Donor creatinine (mg/dL) | 1.2 ± 0.9 | 1.3 ± 0.8 | 1.1 ± 0.7 | 1.2 ± 0.9 | <0.001 |
KDPI ≥ 85 | 2415 (31) | 2226 (77) | 79 (12) | 110 (3) | <0.001 |
HLA mismatch, median (IQR) | 4 (4, 5) | 5 (4, 5) | 4 (2, 5) | 4 (3, 5) | <0.001 |
Cold ischemia time (hours) | 19.3 ± 9.2 | 21.2 ± 9.5 | 18.9 ± 8.7 | 18.1 ± 8.8 | <0.001 |
Kidney on pump | 4546 (58) | 1888 (65) | 341 (50) | 2317 (54) | <0.001 |
Allocation type
| <0.001 | ||||
5374 (68) | 1754 (60) | 401 (58) | 3219 (75) | ||
1313 (17) | 690 (24) | 95 (14) | 528 (12) | ||
1189 (15) | 459 (16) | 191 (28) | 539 (13) | ||
EBV status
| 0.004 | ||||
34 (0.4) | 4 (0.1) | 8 (1) | 22 (1) | ||
7199 (91) | 2660 (92) | 622 (91) | 3917 (91) | ||
643 (8) | 239 (8) | 57 (8) | 347 (8) | ||
CMV status
| <0.001 | ||||
865 (11) | 224 (8) | 67 (10) | 574 (13) | ||
1850 (23) | 508 (18) | 214 (31) | 1128 (26) | ||
3681 (47) | 1633 (56) | 302 (44) | 1746 (41) | ||
1480 (19) | 538 (19) | 104 (15) | 838 (20) | ||
Induction immunosuppression
| |||||
4550 (58) | 1583 (55) | 448 (65) | 2519 (59) | <0.001 | |
1226 (16) | 420 (14) | 132 (19) | 674 (16) | 0.008 | |
1593 (20) | 745 (26) | 61 (9) | 787 (18) | <0.001 | |
178 (2) | 90 (3) | 16 (2) | 72 (2) | <0.001 | |
691 (9) | 254 (9) | 52 (8) | 385 (9) | 0.48 | |
Maintenance Immunosuppression
| |||||
7081 (90) | 2576 (89) | 617 (90) | 3888 (91) | 0.02 | |
147 (2) | 34 (1) | 17 (2) | 96 (2) | 0.002 | |
7194 (91) | 2634 (91) | 634 (92) | 3926 (92) | 0.29 | |
23 (0.3) | 3 (0.10 | 3 (0.4) | 17 (0.4) | 0.06 | |
96 (1) | 36 (1) | 4 (1) | 56 (1) | 0.27 | |
5328 (68) | 1900 (65) | 527 (77) | 2901 (68) | <0.001 |
Cluster 1 | Cluster 2 | Cluster 3 | |
---|---|---|---|
Primary non-function | 39 (1.3) | 4 (0.6) | 35 (0.8) |
OR for primary non-function | 1.65 (1.05–2.62) | 0.71 (0.25–2.01) | 1 (ref) |
Delayed graft function | 991 (34) | 241 (35) | 1282 (30) |
OR for delayed graft function | 1.21 (1.10–1.34) | 1.27 (1.07–1.50) | 1 (ref) |
1-year survival | 93.2% | 96.4% | 96.5% |
HR for 1-year death | 2.01 (1.60–2.51) | 1.02 (0.65–1.60) | 1 (ref) |
5-year survival | 68.8% | 83.6% | 81.4% |
HR for 5-year death | 1.92 (1.69–2.17) | 0.97 (0.75–1.24) | 1 (ref) |
1-year death-censored graft survival | 91.9% | 91.8% | 95.4% |
HR for 1-year death-censored graft failure | 1.81 (1.48–2.20) | 1.80 (1.32–2.45) | 1 (ref) |
5-year death-censored graft survival | 76.6% | 78.1% | 82.1% |
HR for 5-year death-censored graft failure | 1.46 (1.28–1.66) | 1.36 (1.09–1.67) | 1 (ref) |
1-year acute rejection | 183 (6.3) | 53 (7.7) | 253 (5.9) |
OR for 1-year acute rejection | 1.07 (0.88–1.31) | 1.33 (0.98–1.81) | 1 (ref) |
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Thongprayoon, C.; Miao, J.; Jadlowiec, C.C.; Mao, S.A.; Mao, M.A.; Leeaphorn, N.; Kaewput, W.; Pattharanitima, P.; Tangpanithandee, S.; Krisanapan, P.; et al. Differences between Kidney Transplant Recipients from Deceased Donors with Diabetes Mellitus as Identified by Machine Learning Consensus Clustering. J. Pers. Med. 2023, 13, 1094. https://doi.org/10.3390/jpm13071094
Thongprayoon C, Miao J, Jadlowiec CC, Mao SA, Mao MA, Leeaphorn N, Kaewput W, Pattharanitima P, Tangpanithandee S, Krisanapan P, et al. Differences between Kidney Transplant Recipients from Deceased Donors with Diabetes Mellitus as Identified by Machine Learning Consensus Clustering. Journal of Personalized Medicine. 2023; 13(7):1094. https://doi.org/10.3390/jpm13071094
Chicago/Turabian StyleThongprayoon, Charat, Jing Miao, Caroline C. Jadlowiec, Shennen A. Mao, Michael A. Mao, Napat Leeaphorn, Wisit Kaewput, Pattharawin Pattharanitima, Supawit Tangpanithandee, Pajaree Krisanapan, and et al. 2023. "Differences between Kidney Transplant Recipients from Deceased Donors with Diabetes Mellitus as Identified by Machine Learning Consensus Clustering" Journal of Personalized Medicine 13, no. 7: 1094. https://doi.org/10.3390/jpm13071094