External validation of the estimated posttransplant survival score for allocation of deceased donor kidneys in the United States

P. A. Clayton, S. P. McDonald, J. J. Snyder, N. Salkowski, S. J. Chadban

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

The US kidney allocation system adopted in 2013 will allocate the best 20% of deceased donor kidneys (based on the kidney donor risk index [KDRI]) to the 20% of waitlisted patients with the highest estimated posttransplant survival (EPTS). The EPTS has not been externally validated, raising concerns as to its suitability to discriminate between kidney transplant candidates. We examined EPTS using data from the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry. We included 4983 adult kidney-only deceased donor transplants over 2000-2011. We constructed three Cox models for patient survival: (i) EPTS alone; (ii) EPTS plus donor age, hypertension and HLA-DR mismatch; and (iii) EPTS plus log(KDRI). All models demonstrated moderately good discrimination, with Harrell's C statistics of 0.67, 0.68 and 0.69, respectively. These results are virtually identical to the internal validation that demonstrated a c-statistic of 0.69. These results provide external validation of the EPTS as a moderately good tool for discriminating posttransplant survival of adult kidney-only transplant recipients. The estimated posttransplant survival score, which will be used to prioritize allocation of the best 20% of deceased donor kidneys in the United States, is moderately good at discriminating posttransplant survival of adult kidney-only transplant recipients, even in an external dataset with differing donor, recipient, and allocation system characteristics.

LanguageEnglish
Pages1922-1926
Number of pages5
JournalAmerican Journal of Transplantation
Volume14
Issue number8
DOIs
Publication statusPublished - 1 Jan 2014
Externally publishedYes

Keywords

  • Deceased donor
  • kidney allocation
  • kidney transplantation
  • patient survival

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)

Cite this

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abstract = "The US kidney allocation system adopted in 2013 will allocate the best 20{\%} of deceased donor kidneys (based on the kidney donor risk index [KDRI]) to the 20{\%} of waitlisted patients with the highest estimated posttransplant survival (EPTS). The EPTS has not been externally validated, raising concerns as to its suitability to discriminate between kidney transplant candidates. We examined EPTS using data from the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry. We included 4983 adult kidney-only deceased donor transplants over 2000-2011. We constructed three Cox models for patient survival: (i) EPTS alone; (ii) EPTS plus donor age, hypertension and HLA-DR mismatch; and (iii) EPTS plus log(KDRI). All models demonstrated moderately good discrimination, with Harrell's C statistics of 0.67, 0.68 and 0.69, respectively. These results are virtually identical to the internal validation that demonstrated a c-statistic of 0.69. These results provide external validation of the EPTS as a moderately good tool for discriminating posttransplant survival of adult kidney-only transplant recipients. The estimated posttransplant survival score, which will be used to prioritize allocation of the best 20{\%} of deceased donor kidneys in the United States, is moderately good at discriminating posttransplant survival of adult kidney-only transplant recipients, even in an external dataset with differing donor, recipient, and allocation system characteristics.",
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External validation of the estimated posttransplant survival score for allocation of deceased donor kidneys in the United States. / Clayton, P. A.; McDonald, S. P.; Snyder, J. J.; Salkowski, N.; Chadban, S. J.

In: American Journal of Transplantation, Vol. 14, No. 8, 01.01.2014, p. 1922-1926.

Research output: Contribution to journalArticle

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