TY - JOUR
T1 - Validation of the Prognostic Kidney Donor Risk Index Scoring System of Deceased Donors for Renal Transplantation in the Netherlands
AU - Peters-Sengers, Hessel
AU - Heemskerk, Martin B. A.
AU - Geskus, Ronald B.
AU - Kers, Jesper
AU - Homan van der Heide, Jaap J.
AU - Berger, Stefan P.
AU - Bemelman, Frederike J.
PY - 2018
Y1 - 2018
N2 - Background. The prognostic Kidney Donor Risk Index (KDRI)-developed and internally validated in the United States-is a widely used tool to predict transplant outcome of a deceased donor kidney. The KDRI is currently used for longevity matching between donors and recipients in the United States. Methods. We aimed to externally validate the KDRIdonor-only and KDRIfull as proposed by Rao et al (2009). KDRIdonor-only consist of 10 donor factors, and KDRIfull with an additional 4 transplant factors. We used the Dutch Organ Transplantation Registry to include 3201 adult recipients transplanted from 2002 to 2012. Results. The median Dutch KDRI was 1.21 and comparable with the year 2012 in the United States (median of 1.24). The calibrationslope was 0.98 and 0.96 for the KDRIfull and KDRIdonor-only, respectively, indicating that predictions of graft failure were on average similar. The discriminative ability (Harrell C) of the KDRIfull and the KDRIdonor-only at 5 years was 0.63 (95% confidence interval [CI], 0.62-0.64), and 0.62 (95% CI, 0.61-0.63), respectively. We found misspecification of 3 KDRI factors: age (P = 0.002), weight (P = 0.017), and cold ischemia time (P <0.001). Adding the use of inotropic drugs before donation (P = 0.040) and the interaction between circulatory-death donor kidneys and prolonged cold ischemic time (> 24 hours vs 12 hours; P = 0.059) could improve predictive ability. Conclusions. The KDRI performs equal in the Dutch population. Discriminative ability of the KDRI indicates limited clinical use for adequate individualized decisions. An updated KDRImay contribute to a standardized policymeeting the growing demand of donor kidneys in the Eurotransplant region
AB - Background. The prognostic Kidney Donor Risk Index (KDRI)-developed and internally validated in the United States-is a widely used tool to predict transplant outcome of a deceased donor kidney. The KDRI is currently used for longevity matching between donors and recipients in the United States. Methods. We aimed to externally validate the KDRIdonor-only and KDRIfull as proposed by Rao et al (2009). KDRIdonor-only consist of 10 donor factors, and KDRIfull with an additional 4 transplant factors. We used the Dutch Organ Transplantation Registry to include 3201 adult recipients transplanted from 2002 to 2012. Results. The median Dutch KDRI was 1.21 and comparable with the year 2012 in the United States (median of 1.24). The calibrationslope was 0.98 and 0.96 for the KDRIfull and KDRIdonor-only, respectively, indicating that predictions of graft failure were on average similar. The discriminative ability (Harrell C) of the KDRIfull and the KDRIdonor-only at 5 years was 0.63 (95% confidence interval [CI], 0.62-0.64), and 0.62 (95% CI, 0.61-0.63), respectively. We found misspecification of 3 KDRI factors: age (P = 0.002), weight (P = 0.017), and cold ischemia time (P <0.001). Adding the use of inotropic drugs before donation (P = 0.040) and the interaction between circulatory-death donor kidneys and prolonged cold ischemic time (> 24 hours vs 12 hours; P = 0.059) could improve predictive ability. Conclusions. The KDRI performs equal in the Dutch population. Discriminative ability of the KDRI indicates limited clinical use for adequate individualized decisions. An updated KDRImay contribute to a standardized policymeeting the growing demand of donor kidneys in the Eurotransplant region
U2 - https://doi.org/10.1097/TP.0000000000001889
DO - https://doi.org/10.1097/TP.0000000000001889
M3 - Article
C2 - 28731905
SN - 0041-1337
VL - 102
SP - 162
EP - 170
JO - Transplantation
JF - Transplantation
IS - 1
ER -