Transplant Epidemiology Group, Australia and New Zealand Dialysis and Transplant Registry, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia; Central and Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia.
Transplant Epidemiology Group, Australia and New Zealand Dialysis and Transplant Registry, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia; Kidney Transplant Program, Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada.
Am J Transplant. 2023 Feb;23(2):232-238. doi: 10.1016/j.ajt.2022.10.001.
The inclusion of blood group- and human leukocyte antigen-compatible donor and recipient pairs (CPs) in kidney paired donation (KPD) programs is a novel strategy to increase living donor (LD) transplantation. Transplantation from a donor with a better Living Donor Kidney Profile Index (LKDPI) may encourage CP participation in KPD programs. We undertook parallel analyses using data from the Scientific Registry of Transplant Recipients and the Australia and New Zealand Dialysis and Transplant Registry to determine whether the LKDPI discriminates death-censored graft survival (DCGS) between LDs. Discrimination was assessed by the following: (1) the change in the Harrell C statistic with the sequential addition of variables in the LKDPI equation to reference models that included only recipient factors and (2) whether the LKDPI discriminated DCGS among pairs of prognosis-matched LD recipients. The addition of the LKDPI to reference models based on recipient variables increased the C statistic by only 0.02. Among prognosis-matched pairs, the C statistic in Cox models to determine the association of the LKDPI with DCGS was no better than chance alone (0.51 in the Scientific Registry of Transplant Recipient and 0.54 in the Australia and New Zealand Dialysis and Transplant Registry cohorts). We conclude that the LKDPI does not discriminate DCGS and should not be used to promote CP participation in KPD programs.
将血型和人类白细胞抗原相容的供受者对（CP）纳入肾配对捐赠（KPD）计划是增加活体供者（LD）移植的一种新策略。来自具有更好活体供者肾脏评分指数（LKDPI）的供者的移植可能会鼓励 CP 参与 KPD 计划。我们使用来自移植受者科学登记处和澳大利亚及新西兰透析和移植登记处的数据进行平行分析，以确定 LKDPI 是否在 LD 之间区分死亡风险校正移植物存活率（DCGS）。通过以下方式评估区分度：（1）在将 LKDPI 方程中的变量依次添加到仅包含受者因素的参考模型中时，Harrell C 统计量的变化；（2）LKDPI 是否在预后匹配的 LD 受者对之间区分 DCGS。将 LKDPI 添加到基于受者变量的参考模型中仅使 C 统计量增加了 0.02。在预后匹配的对中，Cox 模型确定 LKDPI 与 DCGS 之间关联的 C 统计量并不优于随机值（在移植受者科学登记处为 0.51，在澳大利亚和新西兰透析和移植登记处为 0.54）。我们得出结论，LKDPI 不能区分 DCGS，不应用于促进 CP 参与 KPD 计划。
