Department of Nephrology, Monash Medical Centre, Monash Health, 246 Clayton Road, Clayton, Melbourne, VIC, 3168, Australia.
Centre for Inflammatory Diseases, Department of Medicine, Monash University, Clayton, Melbourne, Australia.
BMC Gastroenterol. 2021 Feb 23;21(1):80. doi: 10.1186/s12876-021-01655-2.
Risk indices such as the pancreas donor risk index (PDRI) and pre-procurement pancreas allocation suitability score (P-PASS) are utilised in solid pancreas transplantation however no review has compared all derived and validated indices in this field. We systematically reviewed all risk indices in solid pancreas transplantation to compare their predictive ability for transplant outcomes.
Medline Plus, Embase and the Cochrane Library were searched for studies deriving and externally validating risk indices in solid pancreas transplantation for the outcomes of pancreas and patient survival and donor pancreas acceptance for transplantation. Results were analysed descriptively due to limited reporting of discrimination and calibration metrics required to assess model performance.
From 25 included studies, discrimination and calibration metrics were only reported in 88% and 38% of derivation studies (n = 8) and in 25% and 25% of external validation studies (n = 12) respectively. 21 risk indices were derived with mild to moderate ability to predict risk (C-statistics 0.52-0.78). Donor age, donor body mass index (BMI) and donor gender were the commonest covariates within derived risk indices. Only PDRI and P-PASS were subsequently externally validated, with variable association with post-transplant outcomes. P-PASS was not associated with pancreas graft survival.
Most of the risk indices derived for use in solid pancreas transplantation were not externally validated (90%). PDRI and P-PASS are the only risk indices externally validated for solid pancreas transplantation, and when validated without reclassification measures, are associated with 1-year pancreas graft survival and donor pancreas acceptance respectively. Future risk indices incorporating recipient and other covariates alongside donor risk factors may have improved predictive ability for solid pancreas transplant outcomes.
在实体胰腺移植中，使用风险指数（如胰腺供体风险指数[PDRI]和预采集胰腺分配适宜性评分[P-PASS]），但尚无研究比较该领域中所有推导和验证的指数。我们系统地回顾了实体胰腺移植中的所有风险指数，以比较它们对移植结局的预测能力。
在 Medline Plus、Embase 和 Cochrane 图书馆中搜索了在实体胰腺移植中推导和外部验证风险指数的研究，以评估胰腺和患者生存以及供体胰腺接受移植的结果。由于缺乏评估模型性能所需的区分度和校准度指标的报告，因此仅进行了描述性分析。
从 25 项纳入的研究中，8 项推导研究（n=8）和 12 项外部验证研究（n=12）中分别仅报告了 88%和 38%的推导研究以及 25%和 25%的外部验证研究中报告了区分度和校准度指标。21 个风险指数具有预测风险的中等至轻度能力（C 统计量 0.52-0.78）。推导的风险指数中最常见的协变量是供体年龄、供体体重指数（BMI）和供体性别。仅 PDRI 和 P-PASS 随后进行了外部验证，与移植后结局的相关性各不相同。P-PASS 与胰腺移植物存活率无关。
大多数推导用于实体胰腺移植的风险指数都未进行外部验证（90%）。PDRI 和 P-PASS 是仅有的经过外部验证的实体胰腺移植风险指数，并且在没有重新分类措施的情况下进行验证时，分别与 1 年胰腺移植物存活率和供体胰腺接受率相关。未来的风险指数如果包含受体和其他协变量以及供体风险因素，可能会提高实体胰腺移植结局的预测能力。
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