Abstract
Introduction: Aim was to design, test and validate a new predictive score index for 5-yr kidney graft survival. Methods: Pre-transplant risk factors and pre-implantation biopsy data were evaluated in 601 renal transplants performed from 1997 to 2012. The score points model included donor and recipients data and the implantation biopsy score (IBS). The score system was generated by data collected in 323 pts and tested in 278 pts out of 601. Results: Considering model and test groups, mean recipient age were respectively 45±12 vs 46±12 (p=0.99), 52.5% vs 47.5% males (p=0.43), BMI 24.6 vs 24.5 (p=0.86), glomerulonephritis (GN) 25.7% vs 25.2% (p=0.88), HCV+ in 7.1% vs 9.7% (p=0.25). Donors age were 44±17 vs 46±16 (p=0.22), DD were 90.4% vs 92.8% (p=0.29), ECD were 31.3% for both (p=0.99), mean follow up was 8.2±4.6 vs 8.3±4.4 yr (p=0.93). Variables considered in the proposed model were: recipient age (0-20 yr=-6 points; 21-25=-4 points, with successive increases of +1 point for each 5-year increase category); BMI (between 24 and 32=0 points or out of these limits=+8 points); presence of biopsy-proven GN (=+5 points; absence = 0 points), of HCV+(=+7 points; absence=0 points), HLA-B mismatch (0 or 1 MM=0; 2MM=+7 points) and IBS (0 to 3=0 points; ≥4=+7 points).The final model included biopsy histology because of its net reclassification improvement of 32%; IBS was available in 285 pts. Sum of scores could vary from -6 to +42. Accuracy C-values (AUC ROC) were 0.760 for model (n=323) vs 0.877 for test Group (n=278). The average actual and estimate 5yr graft survival SCD and ECD are seen on table 1:Table: No Caption available.Conclusion: We designed and validated a simple predictive tool to estimate the 5yr-graft survival in renal allograft recipients. This information may be useful to tailor a personalized informed consent form for patients at the time of transplantation.
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