External Validation of the Estimated Posttransplant Survival Score for Allocation of Deceased Donor Kidneys in the United States
External Validation of the Estimated Posttransplant Survival Score for Allocation of Deceased Donor Kidneys in the United States
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DOI：
10.1111/ajt.12761
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发表时间：
2014-08-01
影响因子：
8.8
通讯作者：
Chadban, S. J.
中科院分区：
文献类型：
--
作者：
Clayton, P. A.;McDonald, S. P.;Chadban, S. J.
2013年采用的美国肾脏分配系统将把最好的20%的已故供体肾脏（基于肾脏供体风险指数[KDRI]）分配给估计移植后生存（EPTS）最高的20%等候名单患者。EPTS尚未经过外部验证，这引起了人们对其区分肾移植候选人的适用性的担忧。我们使用澳大利亚和新西兰透析和移植登记处（ANZDATA）的数据来检查EPTS。我们纳入了2000-2011年间4983例成人仅肾死亡供体移植。我们构建了三种患者生存的Cox模型：(i)单独使用EPTS；（ii） EPTS加上供者年龄、高血压和HLA-DR不匹配；（iii） EPTS + log（KDRI）。所有模型均具有较好的判别性，Harrell’s C统计量分别为0.67、0.68和0.69。这些结果实际上与内部验证相同，证明c统计量为0.69。这些结果为EPTS作为鉴别成人纯肾移植受者移植后存活的一种较好的工具提供了外部验证。
The US kidney allocation system adopted in 2013 will allocate the best 20% of deceased donor kidneys (based on the kidney donor risk index [KDRI]) to the 20% of waitlisted patients with the highest estimated posttransplant survival (EPTS). The EPTS has not been externally validated, raising concerns as to its suitability to discriminate between kidney transplant candidates. We examined EPTS using data from the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry. We included 4983 adult kidney-only deceased donor transplants over 2000-2011. We constructed three Cox models for patient survival: (i) EPTS alone; (ii) EPTS plus donor age, hypertension and HLA-DR mismatch; and (iii) EPTS plus log(KDRI). All models demonstrated moderately good discrimination, with Harrell's C statistics of 0.67, 0.68 and 0.69, respectively. These results are virtually identical to the internal validation that demonstrated a c-statistic of 0.69. These results provide external validation of the EPTS as a moderately good tool for discriminating posttransplant survival of adult kidney-only transplant recipients.