Predictive Score Model for Delayed Graft Function Based on Easily Available Variables before Kidney Donation after Cardiac Death.
Ding CG, Tai QH, et al.Chinese Medical Journal 2017; 130(20): 2429-2434.
Aims
To develop a risk score model to evaluate the quality of donation after cardiac death (DCD) kidneys and identify kidneys at the highest risk of delayed graft function (DGF) before DCD.
Interventions
Participants were randomised into development and validation cohorts. Multivariate logistic regression analysis was performed to identify independent predictors of DGF from the development cohort and the validation cohort was used to validate the model.
Participants
543 primary DCD kidney transplant recipients aged 16-70 years.
Outcomes
The primary outcomes measured were DGF (defined as the need for dialysis within the first week after transplantation) and graft failure (defined as return to hemodialysis, transplant nephrectomy, or recipient death with a functioning graft). Other outcomes measured included donor characteristics, cold and warm ischemia time, and recipient characteristics at the time of transplantation.
Follow-up
Not reported
CET Conclusions
This study used logistic regression to find independent predictors of DGF following donation after circulatory death. The predictive model was then validated using the remainder of the cohort. 543 kidney transplants were included (2/3 used for modelling and 1/3 used for the validation test). The strongest predictors of DGF were donor hypotension, donor CPR, donor eGFR and history of hypertension. Cold ischaemic time was not used in the model as donor risk factors only were assessed. On validation in the second part of the cohort, the risk score very closely correlated with the risk of DGF and the c-statistics were not significantly different between the development and validation cohorts. Four categories of DGF risk were therefore formed. The risk of DGF across the whole cohort was only 15%, which seems low, and calls into question how this particular risk prediction model will work in other areas where DGF rates are much higher.
Quality notes
Quality assessment not appropriate
Trial registration
None