Doshi Mona D, Schaubel Douglas E, Xu Yuwen, Rao Panduranga S, Sung Randall S
Division of Nephrology, Department of Medicine, University of Michigan, Ann Arbor, MI.
Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
Transplant Direct. 2022 Jun 17;8(7):e1343. doi: 10.1097/TXD.0000000000001343. eCollection 2022 Jul.
Recent events of racial injustice prompted us to study potential impact of removing race from kidney donor risk index (KDRI) calculator.
We used Scientific Registry for Transplant Recipients data to analyze outcomes of 66 987 deceased-donor kidney transplants performed in the United States between 2010 and 2016. Graft failure (GF) was defined as death or return to dialysis or requiring repeat transplant. We compared original KDRI and a race-free KDRI (Black donor coefficient zeroed out in the KDRI formula) with respect to recategorization of perceived GF risk (based on KDPI categories: ≤20, 21-34, 35-85, ≥86)' risk discrimination (using the C statistic) and predictive accuracy (using Brier score), and GF risk prediction (using Cox regression on time-to-GF). We used logistic regression to study the impact of donor race on discard probability.
There were 10 949 (16.3% of recipients) GF, and 1893 (17% of GFs) were among recipients of kidneys from Black donors. The use of race-free KDRI resulted in reclassification of 49% of kidneys from Black donors into lower GF risk categories. The impact on GF risk discrimination was minimal, with a relative decrease in C statistic of 0.16% and a change in GF predictive accuracy of 0.07%. For a given recipient/donor combination, transplants from Black (compared with non-Black) donors are estimated to decrease predicted graft survival at 1-y by 0.3%-3%, and 5-y by 1%-6%. Kidneys from Black donors are significantly more likely to be discarded (odds ratio adjusted for KDRI except race = 1.24). We estimate that an equal discard probability for Black and non-Black donors would yield 70 additional kidney transplants annually from Black donors.
Use of race-free KDRI did not impact GF risk discrimination or predictive accuracy and may lower discard of kidneys from Black donors. We recommend use of race-free KDRI calculator acknowledging the possibility of miscalculation of GF risk in small proportion of kidneys from Black donors.
近期发生的种族不公正事件促使我们研究从肾脏供体风险指数（KDRI）计算器中去除种族因素的潜在影响。
我们使用移植受者科学登记处的数据，分析了2010年至2016年在美国进行的66987例 deceased-donor 肾脏移植的结果。移植失败（GF）定义为死亡、恢复透析或需要再次移植。我们比较了原始KDRI和无种族KDRI（在KDRI公式中黑人供体系数归零）在感知GF风险重新分类（基于KDPI类别：≤20、21 - 34、35 - 85、≥86）、风险辨别（使用C统计量）和预测准确性（使用Brier评分）以及GF风险预测（使用GF时间的Cox回归）方面的差异。我们使用逻辑回归研究供体种族对丢弃概率的影响。
有10949例（占受者的16.3%）发生GF，其中1893例（占GF的17%）发生在接受黑人供体肾脏的受者中。使用无种族KDRI导致49%的黑人供体肾脏重新分类到较低的GF风险类别。对GF风险辨别的影响最小，C统计量相对下降0.16%，GF预测准确性变化0.07%。对于给定的受者/供体组合，来自黑人（与非黑人相比）供体的移植估计会使1年时预测的移植存活率降低0.3% - 3%，5年时降低1% - 6%。来自黑人供体的肾脏被丢弃的可能性显著更高（调整KDRI除种族外的比值比 = 1.24）。我们估计，黑人与非黑人供体具有相等的丢弃概率将每年从黑人供体中多产生70例肾脏移植。
使用无种族KDRI不会影响GF风险辨别或预测准确性，并且可能降低黑人供体肾脏的丢弃率。我们建议使用无种族KDRI计算器，同时承认在一小部分黑人供体肾脏中可能存在GF风险计算错误的可能性。
