Journal
AMERICAN JOURNAL OF TRANSPLANTATION
Volume 19, Issue 2, Pages 425-433Publisher
ELSEVIER SCIENCE INC
DOI: 10.1111/ajt.14978
Keywords
clinical decision-making; clinical research; practice; epidemiology; kidney transplantation; nephrology; organ acceptance; registry; registry analysis
Categories
Funding
- National Institute of Diabetes and Digestive and Kidney Diseases [K24DK101828]
- Mogam Science Scholarship Foundation
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The impact of donor quality on post-kidney transplant (KT) survival may vary by candidate condition. Characterizing this variation would increase access to KT without sacrificing outcomes. We developed a tool to estimate post-KT survival for combinations of donor quality and candidate condition. We studied deceased donor KT recipients (n=120818) and waitlisted candidates (n=376272) between 2005 and 2016 by using the Scientific Registry of Transplant Recipients. Donor quality and candidate condition were measured by using the Kidney Donor Profile Index (KDPI) and the Estimated Post Transplant Survival (EPTS) score. We estimated 5-year post-KT survival based on combinations of KDPI and EPTS score using random forest algorithms and waitlist survival by EPTS score using Weibull regressions. Survival benefit was defined as absolute reduction in mortality risk with KT. For candidates with an EPTSscore of80, 5-year waitlist survival was 47.6%, and 5-year post-KT survival was 78.9% after receiving kidneys with a KDPIof20 and was 70.7% after receiving kidneys with a KDPIof80. The impact of KDPI on survival benefit varied greatly by EPTS score. For candidates with low EPTS scores (eg, <40), the KDPI had limited impact on survival benefit. For candidates with middle or high EPTS scores (eg, >40), survival benefit decreased with higher KDPI but was still substantial even with a KDPIof100 (>16 percentage points). Our prediction tool () can support individualized decision-making on kidney offers in clinical practice.
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