Kidney Donor Profile Index Does Not Accurately Predict the Graft Survival of Pediatric Deceased Donor Kidneys.
Kidney Donor Profile Index Does Not Accurately Predict the Graft Survival of Pediatric Deceased Donor Kidneys.
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DOI：
10.1097/tp.0000000000001028
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发表时间：
2016-11
期刊：
影响因子：
6.2
通讯作者：
Ross LF
中科院分区：
文献类型：
--
作者：
Parker WF;Thistlethwaite JR Jr;Ross LF
新的已故供体肾脏分配算法使用基于供体特征的肾脏供体概况指数（KDPI）来预测移植物存活率，并将肾脏分为4个质量组（即，KDPI-A、-B、-C和-D）。儿童肾脏占死亡供体肾脏的10-12%。我们假设KDPI无法准确预测儿科供体移植物存活率，并且可以创建上级预测模型。分析了2000-2010年儿童（<10岁）和青少年（10-17岁）供体移植到首次成人受体的移植受体科学登记数据，移植失败是主要结局。两个新的指数，儿童供体指数（CDI）和青少年供体指数（ADI），采用逐步变量删除，以确定显着的模型协变量在考克斯回归。然后根据KDPI和CDI/ADI评分将儿科供体肾脏分为四个质量组。KDPI，CDI和ADI模型的性能进行了比较，相对于新的分配系统定义的四个质量组。在Kaplan-Meier生存分析中，KDPI不能有效区分质量组（除一项比较外，所有比较p> 0.05）。CDI和ADI包括新变量（例如，体重指数（BMI），并成功区分质量组（通过对数秩检验，P<0.05）。当从KDPI转换为CDI和ADI时，净重新分类指数显示出改善，值分别为0.09（p<0.001）和0.073（p<0.001）。KDPI不能准确预测小儿肾移植存活率。替代指数可以提高分配效率。
The new deceased donor kidney allocation algorithm uses a Kidney Donor Profile Index (KDPI) based on donor characteristics to predict graft survival and divides kidneys into 4 quality groups (i.e., KDPI-A, -B, -C, and -D). Pediatric kidneys constitute 10–12% of deceased donor kidneys. We hypothesized that KDPI would not accurately predict pediatric donor graft survival and superior predictive models could be created. Scientific Registry of Transplant Recipients data for years 2000–2010 for transplants from child (<10 years) and adolescent (10–17 years inclusive) donors into first-time adult recipients were analyzed with graft failure as the principle outcome. Two novel indices, Child Donor Index (CDI) and Adolescent Donor Index (ADI), were developed using stepwise variable deletion to identify significant model covariates in a Cox Regression. Pediatric donor kidneys were then classified into the four quality groups based on both KDPI and CDI/ADI scores. The performance of the KDPI, CDI and ADI models were compared with respect to the four quality groups defined by the new allocation system. KDPI did not effectively discriminate between quality groups (p> 0.05 for all but one comparison) in Kaplan-Meier survival analyses. CDI and ADI included novel variables (e.g., body mass index percentiles) and successfully discriminated between quality groups (p<0.05 by log rank test). The Net Reclassification Index showed improvement when switching from KDPI to CDI and ADI, with values of 0.09 (p<0.001) and 0.073 (p<0.001) respectively. KDPI does not accurately predict pediatric kidney graft survival. Alternative indices can improve allocation efficiency.