Zorn Katharina S, Littbarski Simon, Schwager Ysabell, Kaltenborn Alexander, Beneke Jan, Gwiasda Jill, Becker Thomas, Braun Felix, Reichert Benedikt, Klempnauer Jürgen, Schrem Harald
Core Facility Quality Management Transplantation, Integrated Research and Treatment Center Transplantation (IFB-Tx), Hannover Medical School, Hannover, Germany.
Trauma and Orthopedic Surgery, Federal Armed Forces Hospital Westerstede, Westerstede, Germany.
Langenbecks Arch Surg. 2018 Nov;403(7):837-849. doi: 10.1007/s00423-018-1712-z. Epub 2018 Oct 18.
The widening gap between demand and supply of organs for transplantation provides extraordinary challenges for ethical donor organ allocation rules. The transplant community is forced to define favorable recipient/donor combinations for simultaneous kidney-pancreas transplantation. The aim of this study is the development of a prognostic model for the prediction of kidney function 1 year after simultaneous pancreas and kidney transplantation using pre-transplant donor and recipient variables with subsequent internal and external validation.
Included were patients with end-stage renal failure due to diabetic nephropathy. Multivariable logistic regression modeling was applied for prognostic model design with retrospective data from Hannover Medical School, Germany (01.01.2000-31.12.2011) followed by prospective internal validation (01 Jan. 2012-31 Dec. 2015). Retrospective data from another German transplant center in Kiel was retrieved for external model validation via the initially derived logit link function.
The developed prognostic model is able to predict kidney graft function 1 year after transplantation ≥ KDIGO stage III with high areas under the receiver operating characteristic curve in the development cohort (0.943) as well as the internal (0.807) and external validation cohorts (0.784).
The proposed validated model is a valuable tool to optimize present allocation rules with the goal to prevent transplant futility. It might be used to support donor organ acceptance decisions for individual recipients.
器官移植供需差距的不断扩大给符合伦理的供体器官分配规则带来了巨大挑战。移植界被迫为同时进行肾胰联合移植定义有利的受者/供者组合。本研究的目的是开发一种预后模型，用于预测在同时进行胰腺和肾脏移植后1年的肾功能，该模型使用移植前供体和受者变量，并随后进行内部和外部验证。
纳入因糖尿病肾病导致终末期肾衰竭的患者。采用多变量逻辑回归模型进行预后模型设计，使用来自德国汉诺威医学院的回顾性数据（2000年1月1日至2011年12月31日），随后进行前瞻性内部验证（2012年1月1日至2015年12月31日）。通过最初推导的对数链接函数检索来自德国基尔另一个移植中心的回顾性数据，用于外部模型验证。
所开发的预后模型能够预测移植后1年的肾移植功能≥KDIGO III期，在开发队列（0.943）以及内部（0.807）和外部验证队列（0.784）中的受试者工作特征曲线下面积较高。
所提出的经过验证的模型是优化当前分配规则以防止移植无效的有价值工具。它可用于支持针对个体受者的供体器官接受决策。
