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Korean J Transplant 2021; 35(2): 86-92

Published online June 30, 2021

https://doi.org/10.4285/kjt.21.0011

© The Korean Society for Transplantation

Development of predictive score for post-transplant survival based on pre-transplant recipient characteristics

Tai Yeon Koo1,* , Joongyub Lee2,* , Jaeseok Yang3,4

1Department of Internal Medicine, Seongnam Citizens Medical Center, Seongnam, Korea
2Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
3Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
4Transplantation Center, Seoul National University Hospital, Seoul, Korea

Correspondence to: Jaeseok Yang
Transplantation Center, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea
Tel: +82-2-2072-4128
Fax: +82-2-2072-4129
E-mail: jcyjs@snu.ac.kr
*These authors contributed equally to this work.

Received: May 20, 2021; Revised: June 16, 2021; Accepted: June 20, 2021

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background: The new kidney allocation system in the United States has introduced longevity matching, which gives priority to allocating the best quality organs to wait-listed candidates with the longest predicted survival for the efficient utilization of organs that are of limited availability. The estimated post-transplant survival (EPTS) score was developed in the United States to risk-stratify all wait-listed patients. However, prognostic indices used in Western countries were derived from data that may be different for Korea and do not necessarily reflect prognostic values for Korean deceased donor kidney transplantation. Prognostic indices for Korean wait-listed candidates therefore need to be developed from Korean data.
Methods: We analyzed 6,731 adult solitary kidney transplant patients for candidate risk prediction using the national data from the Korean Network for Organ Sharing (KONOS) and National Health Insurance Data Sharing Service (NHISS). Cox regression analysis was used to model the risk of patient death.
Results: The Korean EPTS (K-EPTS) score was developed based on four recipient parameters (age, diabetes mellitus, hepatitis C virus, and duration of dialysis) that showed a significant association with post-transplant survival. K-EPTS scores showed good discrimination (C-statistics: 0.690; 95% confidence interval, 0.666–0.715). Moreover, the ability of the K-EPTS score to discriminate patient survival was better than that of the EPTS according to the criteria of the United Network for Organ Sharing (US-EPTS) score (P<0.001).
Conclusions: The K-EPTS score, which was developed based on Korean national data, is expected to contribute to the assessment of recipient prognosis and efficient utilization of deceased donor kidneys.

Keywords: Kidney transplantation, Prognosis, Survival, Transplant recipient

HIGHLIGHTS
  • Korean estimated post-transplant survival (K-EPTS) score was developed based on four parameters (age, diabetes mellitus, hepatitis C virus, and dialysis duration).

  • K-EPTS score showed good discrimination (C-statistics: 0.690; 95% confidence interval, 0.666–0.715).

  • The K-EPTS score could assess recipient prognosis after kidney transplantation in Korea.

  • The K-EPTS score could contribute to efficient utilization of deceased donor kidneys.