The MKTS: An Early Prognostic Score of Mortality After Kidney Transplantation.

Abstract

A.Background: The risk of death after kidney transplantation varies between patients, and is associated with the variation in transplantation benefit. In this context, developing early prognostic mortality scores in renal transplant recipients is thus useful for personalizing the medical decision-making process. B.Methods: We developed a pre-transplant score, called MKTS, from a French prospective and multicentric cohort of 6,648 adult renal transplant recipients included between 2000 and 2012. The initial cohort was divided into two samples for training and validation. In order to construct the MKTS, we performed a parametric survival analysis from the training set. Its predictive capacities were evaluated by estimating the area under time-dependent ROC curves (AUC) from the validation set. C.Results: The MKTS includes five variables: recipient age, time on dialysis before the surgery, history of diabetes and cardiovascular event, and number of previous transplantations. For a prognostic time at 10-year post-transplantation, the AUC associated with the MKTS was 0.74 (95% CI=[0.68-0.79]). Additionally, we proposed two cut-offs based on predictive values in order to stratify patients into three groups according to their risk of death. It is possible to use the MKTS through an application available at http://www.divat.fr/en/online-calculators/mkts. D.Conclusion: This prognostic scoring system constitutes a useful tool for clinicians in patient transplant prioritization. Even if further validations on external and international cohorts are required, we have demonstrated that the MKTS outperformed existing scoring systems and can be computed early.