% Unofficial University of Cambridge Poster Template % https://github.com/andiac/gemini-cam % a fork of https://github.com/anishathalye/gemini % also refer to https://github.com/k4rtik/uchicago-poster \documentclass[final]{beamer} % ==================== % Packages % ==================== \usepackage[T1]{fontenc} \usepackage{lmodern} \usepackage[orientation=portrait,size=a0,scale=1.0]{beamerposter} \usetheme{gemini} \usecolortheme{nott} \usepackage{graphicx} \usepackage{booktabs} \usepackage{tikz} \usepackage{pgfplots} \pgfplotsset{compat=1.14} \usepackage{anyfontsize} \usepackage{ragged2e} \let\olditem\item \renewcommand\item{\olditem\justifying} % ==================== % Lengths % ==================== \bibliographystyle{unsrt} % If you have N columns, choose \sepwidth and \colwidth such that % (N+1)*\sepwidth + N*\colwidth = \paperwidth \newlength{\sepwidth} \newlength{\colwidth} \setlength{\sepwidth}{0.025\paperwidth} \setlength{\colwidth}{0.45\paperwidth} \newcommand{\separatorcolumn}{\begin{column}{\sepwidth}\end{column}} \setbeamertemplate{itemize/enumerate subbody begin}{\large} \setbeamertemplate{itemize/enumerate subsubbody begin}{\large} % ==================== % Title % ==================== \title{Development and Validation of a french kidney donor marginality score} \author{Corentin Choisy \inst{1} \and Magali Giral \inst{2,3} \and Etienne Dantan \inst{1}} \institute[shortinst]{\inst{1} SPHERE UMR 1246, Nantes Université, Univ Tours, CHU Nantes, Inserm, Nantes, France \and \inst{2} CR2TI UMR 1064, Nantes Université, ITUN, CHU Nantes, RTRS Centaure, Nantes, France \and \inst{3} Centre d'Investigation Clinique en Biothérapie, Nantes, France} % ==================== % Footer (optional) % ==================== \footercontent{ \href{https://www.divat.fr/}{https://www.sphere-inserm.fr/} \hfill Congrès Nan'thèse 2023, Nantes --- France \hfill \href{mailto:corentin.choisy@univ-nantes.fr}{corentin.choisy@univ-nantes.fr}} % (can be left out to remove footer) \newcommand{\myitem}{\item[--]} % ==================== % Logo (optional) % ==================== % use this to include logos on the left and/or right side of the header: \logoright{\includegraphics[height=2em]{logos/transp.png}} \logoleft{\includegraphics[height=2em]{logos/transp.png}} % ==================== % Body % ==================== \begin{document} % Refer to https://github.com/k4rtik/uchicago-poster % logo: https://www.cam.ac.uk/brand-resources/about-the-logo/logo-downloads % \addtobeamertemplate{headline}{} % { % \begin{tikzpicture}[remember picture,overlay] % \node [anchor=north west, inner sep=3cm] at ([xshift=-2.5cm,yshift=1.75cm]current page.north west) % {\includegraphics[height=7cm]{logos/unott-logo.eps}}; % \end{tikzpicture} % } \begin{frame}[t] \begin{columns}[t] \separatorcolumn \begin{column}{\colwidth} \begin{block}{Background} \begin{itemize} \item \textbf{Kidney transplantation (KT)}: recognised as the best treatment for \textbf{end-stage chronic renal disease} \begin{itemize} \setlength{\itemindent}{1em} \item \textbf{Graft shortage} in countries with aging population \textbf{\textcolor{nottblue}{$\Rightarrow$ Necessity for expansion of graft pool}} \end{itemize} \item Wide use of \textbf{marginal grafts} with suboptimal properties for patient-graft survival \item Decision making tools to assist clinicians in evaluating graft proposals \begin{itemize} \setlength{\itemindent}{1em} \item \textbf{ECD \cite{metzger2003expanded}} Older than 60 years old or between 50 and 59 with at least 2 comorbidities among: high serum creatinine, history of hypertension and death by CVA \textbf{\textcolor{nottblue}{$\Rightarrow$ Binary criterion, no gradient between less and more marginal donors}} \item \textbf{KDRI/KDPI \cite{rao2009comprehensive}} Continuous/percentile scale defined by 10 donor features \textbf{\textcolor{nottblue}{$\Rightarrow$ Not adapted to the french population \cite{dantan2021covariates} and prone to increased graft refusal rate \cite{aubert2019disparities}}} \end{itemize} \end{itemize} \vskip-0.5em {\centering\includegraphics[scale=1.6]{Images/Chronic renal disease prevalence.pdf}\par} \vskip-1em \end{block} \begin{block}{Objectives} Develop and validate a \textbf{\textcolor{nottblue}{kidney donor marginality score}}, \textbf{adapted to the french population} and \textbf{suited for the current practices} in KT in France \begin{itemize} \item \textbf{Donor/recipient interactions} will be studied in order to express donor marginality in relation to recipient characteristics \item \textcolor{darkgray}{\textbf{Recipient loss-of-chance} related to receiving a marginal graft as defined by the proposed score will be studied} \end{itemize} \end{block} \begin{alertblock}{Materials and Methods} \begin{itemize} \item \textbf{7622 patients} from the DIVAT national kidney transplant cohort \item First-time deceased donor graft recipients without donor-recipient ABO incompatibility \item \textbf{Multivariate Cox regression} model built via blockwise variable selection approach (Donor/Graft/Recipient features integrated/removed from the model in 11 steps) \item Assessment of \textbf{period/center effect} via adjusted and frailty models \item New variable selection steps after integration of period/center effects \end{itemize} {\centering\includegraphics[scale=0.36]{Images/analyse.png}\par} {\centering\small \textbf{Variable selection process} (square nodes indicate all previously included predictors were forced in the model during backward selection, circle nodes indicate no variable was forced)\par} \end{alertblock} \begin{block}{Funding} \centering This work was supported by the French Biomedicine Agency (reference: AOR Greffe 2022) \end{block} \vskip-0.15em \begin{block}{} {\centering\includegraphics[scale=0.8]{logos/logband.png}\par} \end{block} \end{column} \separatorcolumn \begin{column}{\colwidth} \begin{block}{Results} \vskip-1em \begin{figure} \centering \includegraphics[scale=1.5]{Images/km_global.pdf} \vskip-1.25em \caption{Patient/allograft survival analysis} \label{fig:km} \end{figure} \begin{table}[] \centering \begin{tabular}{@{}lcccc@{}} \toprule & \beta & 95\% CI \\ \midrule Donor age & -0.020 & {[-0.037}-- {-0.003]} \\ Donor after cardiac death & 0.691 & {[0.416}--{0.967]} \\ Donor death by CVA & -0.616 & {[-1.224}-- {-0.008]} \\ Donor serum creatinine & 0.001 & {[0.0001}--{0.002]} \\ Donor height & -0.011 & {[-0.018}-- {-0.004]} \\ Donor weight & 0.005 & {[0.001}--{0.010]} \\ Positive donor CMV serology & 0.124 & {[0.010}--{0.239]} \\ \addlinespace\addlinespace \textcolor{darkgray}{\textbf{HLA incompatibilities \geq 4}} & 0.151 & {[0.009}--{0.293]} \\ Time on dialysis & 0.0001 & {[0.0001}--{0.0001]} \\ Transplanted before 2012 & 0.190 & {[0.040}--{0.340]} \\ \addlinespace\addlinespace Recipient age & -0.021 & {[-0.036}-- {-0.005]} \\ Recipient BMI & 0.011 & {[-0.003}--{0.025]} \\ Recipient history of diabetes & 0.376 & {[0.234}--{0.517]} \\ Recipient history of cardiovascular disease & 0.408 & {[0.239}--{0.527]} \\ Hemodialysis & 0.250 & {[0.048}--{0.452]} \\ \textcolor{darkgray}{\textbf{Donor age*Recipient age}} & 0.001 & {[0.0001}--{0.001]} \\ \textcolor{darkgray}{\textbf{Donor death by CVA*Recipient age}} & 0.014 & {[0.003}--{0.024]} \\ \bottomrule \end{tabular} \caption{\label{mod-table}Proportional hazards Cox model analysis of retained factors and interactions after multivariate selection} \end{table} \vskip-1em \begin{itemize} \item Donor age, beating heart status ($HR=2.00$), cause of death, creatininemia, height, weight and CMV serology ($HR=1.13$) will be integrated into the score. For a given donor, the score will differ depending on recipient age and donor/recipient HLA ABDR incompatibilities. \end{itemize} \end{block} \vskip-0.5em \begin{exampleblock}{What's next} \vskip0.3em \begin{itemize} \item \textbf{Internal validation} of the model, $\frac{1}{3}$ of the database allocated to a random validation sample \item \textbf{Validity assessed through:} \begin{itemize} \setlength{\itemindent}{1em} \item \textbf{Calibration:} calibration plot, predicted survival by score quantile, Brier score \item \textbf{Discrimination:} time-dependent ROC curve (AUC, PPV/NPV) and time-dependent ROC curve per recipient strata \end{itemize} \item \textbf{Propensity score}-based analysis to estimate population-averaged effects and propose a recipient loss-of-chance-based approach \item Development of an \textbf{online score computation tool} for clinicians \end{itemize} \end{exampleblock} \vskip-1em \begin{block}{References} \vskip-0.15em \nocite{*} \footnotesize{\bibliographystyle{plain}\bibliography{poster}} \end{block} \end{column} \separatorcolumn \end{columns} \end{frame} \end{document}