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A modified Kidney Donor Risk Index for pediatric kidney transplant recipients
Pediatric Nephrology ( IF 3 ) Pub Date : 2022-09-06 , DOI: 10.1007/s00467-022-05722-y
Ashley Montgomery 1 , Cameron Goff 1 , Bolatito Adeyeri 1 , Liam D Ferreira 1 , Spoorthi Kamepalli 1 , Jake Lynn 1 , Nhu Thao Nguyen Galvan 2 , Poyyapakkam R Srivaths 3 , Eileen D Brewer 3 , Abbas Rana 2
Affiliation  

Background

The Kidney Donor Risk Index (KDRI) by Rao et al. was developed to measure the quality of kidney allografts. While Rao’s KDRI has been found to be a robust measure of kidney allograft survival for adult kidney transplant recipients, many studies have indicated the need to create a distinct pediatric KDRI.

Methods

Our retrospective study utilized data from the United Network for Organ Sharing database. We examined 9295 deceased donor recipients’ data for age < 18 years from 1990 to 2020. We performed a multivariate Cox regression to determine the significant recipient and transplant factors impacting pediatric kidney allograft survival.

Results

Multivariate analysis found 5 donor factors to be independently associated with graft failure or recipient death: age, female sex, anoxia as the cause of death, history of cigarette use, and cold ischemia time. Using receiver operator characteristic (ROC) curve analysis and analyzing the predictive value of each KDRI at 1, 5, and 10 years, the proposed pediatric KDRI had a statistically significant and higher predictive value for pediatric recipients at 5 (0.60 versus 0.57) and 10 years (0.61 versus 0.57) than the Rao KDRI.

Conclusions

The proposed pediatric KDRI may provide a more accurate and simpler index to assess the quality of kidney allografts for pediatric recipients. However, due to the mild increase in predictive capabilities over the Rao index, the study serves as a proof of concept to develop a pediatric KDRI. Further studies should focus on increasing the index’s predictive capabilities.

Graphical abstract



中文翻译:

针对小儿肾移植受者的改良肾脏供体风险指数

背景

Rao 等人的肾脏供体风险指数 (KDRI)。开发用于测量肾脏同种异体移植物的质量。虽然 Rao 的 KDRI 已被发现是衡量成人肾移植受者肾脏同种异体移植物存活率的有力指标,但许多研究表明需要创建一个独特的儿科 KDRI。

方法

我们的回顾性研究使用了器官共享联合网络数据库中的数据。我们检查了 1990 年至 2020 年年龄 < 18 岁的 9295 名已故供体接受者的数据。我们进行了多变量 Cox 回归以确定影响儿科肾脏同种异体移植物存活的重要接受者和移植因素。

结果

多变量分析发现 5 个供体因素与移植物失败或受体死亡独立相关:年龄、女性、缺氧作为死亡原因、吸烟史和冷缺血时间。使用接受者操作员特征 (ROC) 曲线分析并分析每个 KDRI 在 1、5 和 10 年的预测值,拟议的儿科 KDRI 对儿科接受者在 5(0.60 对 0.57)和 10 时具有统计学意义和更高的预测值年(0.61 对 0.57)比 Rao KDRI。

结论

拟议的儿科 KDRI 可能提供更准确和更简单的指标来评估儿科受者肾脏同种异体移植物的质量。然而,由于 Rao 指数的预测能力略有提高,该研究可作为开发儿科 KDRI 的概念证明。进一步的研究应侧重于提高指数的预测能力。

图形概要

更新日期:2022-09-06
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