Dataset Information

Evaluation of predictive models for delayed graft function of deceased kidney transplantation.

ABSTRACT: This study aimed to evaluate the predictive power of five available delayed graft function (DGF)-prediction models for kidney transplants in the Chinese population.Among the five models, the Irish 2010 model scored the best in performance for the Chinese population. Irish 2010 model had an area under the receiver operating characteristic (ROC) curve of 0.737. Hosmer-Lemeshow goodness-of-fit test showed that the Irish 2010 model had a strong correlation between the calculated DGF risk and the observed DGF incidence (p = 0.887). When Irish 2010 model was used in the clinic, the optimal upper cut-off was set to 0.5 with the best positive likelihood ratio, while the lower cut-off was set to 0.1 with the best negative likelihood ratio. In the subgroup of donor aged ? 5, the observed DGF incidence was significantly higher than the calculated DGF risk by Irish 2010 model (27% vs. 9%).A total of 711 renal transplant cases using deceased donors from China Donation after Citizen's Death Program at our center between February 2007 and August 2016 were included in the analysis using the five predictive models (Irish 2010, Irish 2003, Chaphal 2014, Zaza 2015, Jeldres 2009).Irish 2010 model has the best predictive power for DGF risk in Chinese population among the five models. However, it may not be suitable for allograft recipients whose donor aged ? 5-year-old.

SUBMITTER: Zhang H

PROVIDER: S-EPMC5788595 | biostudies-literature | 2018 Jan

REPOSITORIES: biostudies-literature

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Evaluation of predictive models for delayed graft function of deceased kidney transplantation.

Zhang Huanxi H Zheng Linli L Qin Shuhang S Liu Longshan L Yuan Xiaopeng X Fu Qian Q Li Jun J Deng Ronghai R Deng Suxiong S Yu Fangchao F He Xiaoshun X Wang Changxi C

Oncotarget 20171127 2

<h4>Background</h4>This study aimed to evaluate the predictive power of five available delayed graft function (DGF)-prediction models for kidney transplants in the Chinese population.<h4>Results</h4>Among the five models, the Irish 2010 model scored the best in performance for the Chinese population. Irish 2010 model had an area under the receiver operating characteristic (ROC) curve of 0.737. Hosmer-Lemeshow goodness-of-fit test showed that the Irish 2010 model had a strong correlation between ...[more]

PMID: 29416727

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Project description:Several recipient biomarkers are reported to predict graft dysfunction, but these are not useful in decision making for the acceptance or allocation of deceased donor kidneys; thus, it is necessary to develop donor biomarkers predictive of graft dysfunction. To address this issue, we prospectively enrolled 94 deceased donors and their 109 recipients who underwent transplantation between 2010 and 2013 at 4 Korean transplantation centers. We investigated the predictive values of donor urinary neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), and L-type fatty acid binding protein (L-FABP) for reduced graft function (RGF). We also developed a prediction model of RGF using these donor biomarkers. RGF was defined as delayed or slow graft function. Multiple logistic regression analysis was used to generate a prediction model, which was internally validated using a bootstrapping method. Multiple linear regression analysis was used to assess the association of biomarkers with 1-year graft function. Notably, donor urinary NGAL levels were associated with donor AKI (P = 0.014), and donor urinary NGAL and L-FABP were predictive for RGF, with area under the receiver-operating characteristic curves (AUROC) of 0.758 and 0.704 for NGAL and L-FABP, respectively. The best-fit model including donor urinary NGAL, L-FABP, and serum creatinine conveyed a better predictive value for RGF than donor serum creatinine alone (P = 0.02). In addition, we generated a scoring method to predict RGF based on donor urinary NGAL, L-FABP, and serum creatinine levels. Diagnostic performance of the RGF prediction score (AUROC 0.808) was significantly better than that of the DGF calculator (AUROC 0.627) and the kidney donor profile index (AUROC 0.606). Donor urinary L-FABP levels were also predictive of 1-year graft function (P = 0.005). Collectively, these findings suggest donor urinary NGAL and L-FABP to be useful biomarkers for RGF, and support the use of a new scoring system based on donor biomarkers to facilitate decision-making in acceptance and allocation of deceased donor kidneys and contribute to maximal organ utilization.

Project description:Background and objectivesDelayed graft function is a form of AKI resulting from ischemia-reperfusion injury. Our aim was to study the effect of delayed graft function on the progression of interstitial fibrosis after deceased donor kidney transplantation.Design, setting, participants, & measurementsOur study is a retrospective study of all patients transplanted at our center between July of 2003 and September of 2014 using a kidney from a deceased donor. The primary outcome was the progression of interstitial fibrosis on serial protocol biopsies done during the first year post-transplant. We analyzed the distribution of the change in the Banff interstitial fibrosis (ci) score between the delayed graft function and nondelayed graft function groups for all of the paired biopsies done at time 0 and 12 months post-transplant (?fibrosis). We also performed a linear mixed model analyzing the difference in the slopes for the progression of mean Banff ci score for all of the biopsies done at time 0 and 1, 4, and 12 months post-transplant.ResultsThere were 343 (36.7%) in the delayed graft function group and 591 in the control group. The biopsy rates for the delayed graft function and nondelayed graft function groups at time 0 were 65.3% (n=224) and 67.0% (n=396), respectively, and at 12 months, they were 64.4% (n=221) and 68.4% (n=404), respectively. Paired biopsies were available for 155 in the delayed graft function group and 283 in the control group. In a risk-adjusted model, Banff ci score >0 on the time 0 biopsy had a higher odds of delayed graft function (odds ratio, 1.70; 95% confidence interval, 1.03 to 2.82). The distribution of the ?fibrosis between 0 and 12 months was similar in delayed graft function and control groups (P=0.91). The slopes representing the progression of fibrosis were also similar between the groups (P=0.66).ConclusionsDonor-derived fibrosis may increase the odds of delayed graft function; however, delayed graft function does not seem to increase the progression of fibrosis during the first year after transplantation.

Dataset Information

Evaluation of predictive models for delayed graft function of deceased kidney transplantation.

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Evaluation of predictive models for delayed graft function of deceased kidney transplantation.

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