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Who can tolerate a marginal kidney? Predicting survival after deceased donor kidney transplant by donor-recipient combination

机译:谁能忍受边缘肾脏? 通过供体 - 受体组合预测死者供体肾移植后的存活

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The impact of donor quality on post-kidney transplant (KT) survival may vary by candidate condition. Characterizing this variation would increase access to KT without sacrificing outcomes. We developed a tool to estimate post-KT survival for combinations of donor quality and candidate condition. We studied deceased donor KT recipients (n=120818) and waitlisted candidates (n=376272) between 2005 and 2016 by using the Scientific Registry of Transplant Recipients. Donor quality and candidate condition were measured by using the Kidney Donor Profile Index (KDPI) and the Estimated Post Transplant Survival (EPTS) score. We estimated 5-year post-KT survival based on combinations of KDPI and EPTS score using random forest algorithms and waitlist survival by EPTS score using Weibull regressions. Survival benefit was defined as absolute reduction in mortality risk with KT. For candidates with an EPTSscore of80, 5-year waitlist survival was 47.6%, and 5-year post-KT survival was 78.9% after receiving kidneys with a KDPIof20 and was 70.7% after receiving kidneys with a KDPIof80. The impact of KDPI on survival benefit varied greatly by EPTS score. For candidates with low EPTS scores (eg, 40), the KDPI had limited impact on survival benefit. For candidates with middle or high EPTS scores (eg, 40), survival benefit decreased with higher KDPI but was still substantial even with a KDPIof100 (16 percentage points). Our prediction tool () can support individualized decision-making on kidney offers in clinical practice.
机译:供体质量对肾后后移植(KT)存活的影响可能因候选病症而异。表征这种变化将增加对KT的访问而不牺牲结果。我们开发了一种估计克尔术后生存的工具,以供捐赠质量和候选病症的组合。我们研究了2005年至2016年在2005年至2016年之间的死者捐赠者KT接受者(N = 120818)(n = 376272)通过科学的移植收件机构。通过使用肾脏供体概况指数(KDPI)测量供体质量和候选病症,并估计移植后的存活(EPTS)得分。我们估计基于KDPI的组合和使用随机森林算法和eveS分数的KDPI和EPTS SINGS的epts Scivive使用Weibull回归的epts suit。存活益处被定义为kt的死亡率风险的绝对降低。对于EPTSSCORE的候选人,5年的候补人生生存率为47.6%,并且在用KDPIOF20接受肾脏接受肾脏后,kT后存活率为78.9%,kdpiof80接受肾脏后70.7%。 KDPI对生存效益的影响通过EPTS得分变化了很大。对于低EPTS分数的候选者(例如,& 40),KDPI对存活效益的影响有限。对于中间或高EPTS评分(例如,& 40)的候选者,即使kdpiof100(& 16个百分点),kdpi的存活效率降低但仍然很大。我们的预测工具()可以支持肾脏实践中的肾脏提供的个性化决策。

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