The following is a summary of “2-Step-scores with optional nephropathology for the prediction of adverse outcomes for brain-dead donor kidneys in Eurotransplant,” published in the April 2024 issue of Nephrology by Ernst et al.
Deciding whether to use or discard the rare and marginal brain-dead donor kidneys in Eurotransplant (ET) countries often lack solid evidence.
Researchers conducted a prospective study to develop and validate 2-step scores reflecting current practice for the prognosis of delayed graft function (DGF) and one-year transplant loss (1y-tl) in six Eurotransplant (ET) countries.
They used a training set of 620 cases for DGF and 711 for 1y-tl, with validation sets n=158 and 162. Step 1 employed logistic regression models, including only clinical predictors, and Step 2 updated risk estimates with nephropathology for relevant risk percentiles.
The results showed that step 1 found higher DGF risk with longer cold ischemia time, donor and recipient BMI, dialysis vintage, HLA-DR mismatches, or recipient CMV lgG positivity. C-statistics were 0.672 and 0.704 for the training and validation set. The accuracy of DGF-prognostication improved at 18% and 36% with nephropathology, including several glomeruli and Banff cv (C-statistics: 0.696 and 0.701). For 1y-tl, the risk increased with cold ischemia time, HLA mismatches, and donor age. C-statistics were 0.700 and 0.769. Banff ct enhanced 1y-tl prediction (C-statistics: 0.706 and 0.765), with suitable calibration on training but moderate on validation. Discrimination was comparable to established scores on validation.
Investigators concluded that 2-Step Scores are adaptable to nephropathology and promise solid outcomes in ET practice. They potentially surpass existing scores with versatility for donation after cardiac death and pump use, offering practical benefits for clinicians.
Source: academic.oup.com/ndt/advance-article-abstract/doi/10.1093/ndt/gfae093/7649367