Faculty of Medicine, University Hospital Magdeburg, Magdeburg, Germany.
University Hospital of Cologne, Cologne, Germany.
Transpl Int. 2023 Oct 12;36:11399. doi: 10.3389/ti.2023.11399. eCollection 2023.
Several scores have been devised for providing a prognosis of outcomes after kidney transplantation. This study is a comprehensive test of these scores in a cohort of deceased donors with kidneys of lower-than-average quality and procurement biopsies. In total, 15 scores were tested on a retrospective cohort consisting of 221 donors, 223 procurement biopsies, and 223 recipient records for performance on delayed graft function, graft function, or death-censored graft loss. The best-performing score for DGF was the purely clinical Chapal score (AUC 0.709), followed by the Irish score (AUC 0.684); for graft function, the Nyberg score; and for transplant loss, the Snoeijs score (AUC 0.630) and the Leuven scores (AUCs 0.637 and 0.620). The only score with an acceptable performance was the Chapal score. Its disadvantage is that knowledge of the cold ischemia time is required, which is not known at allocation. None of the other scores performed acceptably. The scores fared better in discarded kidneys than in transplanted kidneys. Our study shows an unmet need for practical prognostic scores useful at the time of a decision about discarding or accepting deceased donor kidneys of lower-than-average quality in the Eurotransplant consortium.
已经设计了几种评分系统来预测肾移植后的预后。本研究全面测试了这些评分系统在一组质量较低的已故供体和获取活检中的表现。总共对一个包含 221 名供体、223 次获取活检和 223 名受者记录的回顾性队列进行了 15 种评分测试，以评估延迟移植物功能障碍、移植物功能或死亡校正移植物丢失的表现。对于 DGF，表现最好的评分是纯临床 Chapal 评分（AUC 0.709），其次是爱尔兰评分（AUC 0.684）；对于移植物功能，Nyberg 评分；对于移植丢失，Snoeijs 评分（AUC 0.630）和 Leuven 评分（AUCs 0.637 和 0.620）。表现最好的评分是 Chapal 评分。其缺点是需要知道冷缺血时间，而在分配时并不知道冷缺血时间。其他评分都表现不佳。在废弃的肾脏中，这些评分的表现要好于移植的肾脏。我们的研究表明，在欧洲移植协会联盟中，对于决定废弃或接受质量较低的已故供体肾脏时，需要实用的预后评分，但目前还没有这样的评分。
