Premium
What's the score? A comparison of deceased donor kidney scoring systems and correlation with graft outcome
Author(s) -
Jackson Kyle R.,
Munivenkatappa Raghava B.,
Wesson Russell N.,
GaronzikWang Jacqueline,
Massie Allan,
Philosophe Benjamin
Publication year - 2020
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.13802
Subject(s) - medicine , receiver operating characteristic , hazard ratio , confidence interval , cohort , kidney transplantation , transplantation , nomogram , scoring system , proportional hazards model , area under the curve , single center , framingham risk score , surgery , disease
Background A number of deceased donor kidney scoring systems have been developed to predict post‐transplant graft failure. However, studies comparing the predictive ability of these scoring systems to each other are lacking. Methods We used single‐center histopathologic and UNOS data from 140 marginal deceased donor kidneys and transplant recipients to compare the predictive accuracy of the Maryland Aggregate Pathology Index (MAPI), Kidney Donor Risk Index (KDRI), Remuzzi, and Nyberg scoring systems for 2‐year graft survival using time‐dependent receiver operating curves and Kaplan‐Meier analysis. Results MAPI had the highest predictive accuracy (area under curve [AUC] = 0.81) compared to KDRI (AUC = 0.45), Remuzzi (AUC = 0.59), and Nyberg (AUC = 0.63) for 2‐year graft survival. Furthermore, when analyzing each score according to its pre‐defined risk strata, MAPI was the only scoring system for which 2‐year graft survival was significantly different across strata (84.3% for low risk, 56.5% for intermediate risk, and 50% for high risk, P < .001). Additionally, MAPI was the only risk score significantly associated with 2‐year graft survival (hazard ratio per point: 1.12, 95% confidence interval [CI]: 1.01‐1.23, P = .03). Conclusions In a single‐center cohort of biopsied marginal kidneys used for transplantation, MAPI had the best predictive ability of these four scoring systems. When biopsy data are available for kidneys considered for transplantation, the MAPI score may provide additional information that could be used to better identify kidneys likely to have longer graft survival.