Prediction of kidney graft failure using clinical scoring tools

Abstract

Background: Donor organ quality is a key determinant of graft function, and considerable efforts have been made to identify donor and transplant factors predicting inferior outcomes. This has resulted in the development of various scoring tools to aid in allocation of kidneys.

Methods: The performance of four donor quality scoring systems in predicting delayed graft function, and death-censored graft failure was examined in a single-center cohort of 730 consecutive deceased donor kidneys transplanted between 1990 and 2004. The predictive accuracy of the variables was analyzed with receiver operating characteristic curves and graft survival distribution.

Results: The three outcome tools, that is, deceased donor score (DDS; Am J Transplant, 3, 2003, 715), donor risk score (DRS; Am J Transplant, 5, 2005, 757) and kidney donor risk index (KDRI; Transplantation, 88, 2009, 231) provided a significant and equivalent prediction of graft failure by using variables available at time of transplantation (p < 0.01). The risk of delayed graft function was predicted by the (DGF) nomogram (J Am Soc Nephrol, 14, 2003, 2967; Am J Transplant 10, 2010, 2279) with a high degree of discrimination (concordance index of 0.69, p < 0.01).

Conclusions: Our findings validate four pre-operative clinical scoring tools to predict early and late graft outcome in an independent, single-center set of kidney transplants.

Keywords: clinical prediction tools; donor kidney; kidney transplantation; outcomes.