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Activity Number: 612 - Statistics for Clinical Trials and Medical Research
Type: Contributed
Date/Time: Thursday, August 1, 2019 : 8:30 AM to 10:20 AM
Sponsor: ENAR
Abstract #306836 Presentation
Title: A Joint Model for Binary Longitudinal and Right-Censored Survival Data in the Context of Antibody Mediated Rejection After Kidney Transplantation
Author(s): Maarten Coemans* and Aleksandar Senev and Marie-Paule Emonds and Maarten Naesens and Geert Verbeke
Companies: KU Leuven and KU Leuven and KU Leuven and KU Leuven and Catholic University of Leuven
Keywords: joint modeling; survival analysis; mixed models; kidney transplantation; biopsy data
Abstract:

Antibody mediated rejection (ABMR) is the main cause of late kidney graft failure after transplantation and leads to histological damage (ABMRh). We analyzed the effect of having pre-transplant donor-specific antibodies (DSA) on the post-transplant occurrence of ABMRh and evaluated mediation, via ABMRh, of its effect on graft survival. We performed a single-center cohort study, including 985 kidney transplantations (2004-2013) and 4317 biopsies, obtained up to 5 years post-transplant. The effect of pre-transplant DSA on the occurrence of ABMRh and on graft survival was studied using mixed and survival models respectively. Mediation was analyzed using a joint model where a survival model is combined with a logistic mixed model. The mixed model includes a cubic B-spline for post-transplant time, random intercepts and random slopes. The survival model assumes proportional hazards and a flexible baseline hazard. We concluded that, within the first 5 years after transplantation, patients with pre-transplant DSA are more prone to develop ABMRh in the transplanted kidney. In fact, the negative effect of pre-transplant DSA on graft survival is fully mediated by the occurrence of ABMRh.


Authors who are presenting talks have a * after their name.

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