Mediation analysis identifies causal factors that lead to increased rates of kidney transplant failure in patients with peripheral vascular disease.

BACKGROUND

This study aims to identify causal mediators of one-year kidney transplant failure in patients with peripheral vascular disease.

METHODS

Standard Transplant Analysis and Research database was queried for adults who underwent kidney transplantation from 1987 to 2021. Multi-organ transplant, prior transplant, and living donor kidneys were excluded. Causal mediation analysis with 2000 percentile bootstrapping interactions identified mediators of one-year kidney transplant failure.

RESULTS

212,259 patients were included: 16,215 with and 196,044 without peripheral vascular disease. Causal mediators of one-year kidney transplant failure are Kidney Donor Profile Index (proportionate mediation [PM] 17 ​%, p ​< ​0.01, E-value ​= ​1.20), pre-transplant dialysis (PM 19 ​%, p ​< ​0.001, E-value ​= ​1.17), recipient total serum albumin (PM 2 ​%, p ​= ​0.003, E-value ​= ​1.05), and donor hypertension (PM 1 ​%, p ​= ​0.017, E-value ​= ​1.04).

CONCLUSIONS

Several causal mediators increase rates of one-year kidney transplant failure in patients with peripheral vascular disease. Understanding these mediators can improve pre-transplant assessments and post-transplant outcomes.