Development and validation of a prognostic model for kidney function 1 year after combined pancreas and kidney transplantation using pre-transplant donor and recipient variables

Abstract

Purpose: The widening gap between demand and supply of organs for transplantation provides extraordinary challenges for ethical donor organ allocation rules. The transplant community is forced to define favorable recipient/donor combinations for simultaneous kidney-pancreas transplantation. The aim of this study is the development of a prognostic model for the prediction of kidney function 1 year after simultaneous pancreas and kidney transplantation using pre-transplant donor and recipient variables with subsequent internal and external validation.

Methods: Included were patients with end-stage renal failure due to diabetic nephropathy. Multivariable logistic regression modeling was applied for prognostic model design with retrospective data from Hannover Medical School, Germany (01.01.2000-31.12.2011) followed by prospective internal validation (01 Jan. 2012-31 Dec. 2015). Retrospective data from another German transplant center in Kiel was retrieved for external model validation via the initially derived logit link function.

Results: The developed prognostic model is able to predict kidney graft function 1 year after transplantation ≥ KDIGO stage III with high areas under the receiver operating characteristic curve in the development cohort (0.943) as well as the internal (0.807) and external validation cohorts (0.784).

Conclusion: The proposed validated model is a valuable tool to optimize present allocation rules with the goal to prevent transplant futility. It might be used to support donor organ acceptance decisions for individual recipients.

Keywords: Diabetic nephropathy; Donor variables; Post-transplant graft function; Prognostic scores; Recipient variables; Simultaneous pancreas kidney transplantation.

Fig. 1

a Patient flow through the study for the training cohort from Hannover. b Patient flow through the study for the prospective internal validation cohort from Hannover

Fig. 2

Shown is the influence of kidney graft function after the first year classified as KDIGO stage ≥ III on long-term kidney graft survival limited by all-cause graft failure in the combined development and internal validation cohorts from Hannover (p < 0.001, log-rank test)

Fig. 3

a Shown are the results of receiver operating characteristic (ROC) curve analysis of the final prognostic meta model for the prediction of the kidney function (KDIGO ≥ III) 1 year after SPK in the training cohort with an area under the ROC curve (AUROC) of 0.943.b Shown are the results of ROC curve analysis of the final prognostic meta model for the prediction of the kidney function (KDIGO ≥ III) 1 year after SPK in the internal prospective validation cohort with an Area under the ROC curve (AUROC) of 0.807 from Hannover

Fig. 4

Shown are the results of ROC curve analysis of the final prognostic meta model for the prediction of the kidney function (KDIGO ≥ III) 1 year after SPK in the training cohort with an AUROC of 0.784 for the external retrospective validation cohort from Kiel

Fig. 5

Shown are the predicted probabilities of renal graft function KDIGO ≥ III 1 year after SPK using the proposed prognostic model with pre-transplant donor and recipient data versus actually observed KDIGO stages after 1 year