External validation of a prognostic model predicting renal graft function one year after brain-dead donor kidney transplantation

Langenbeck s Archives of Surgery, vol. 411, pp. 77

Abstract

PURPOSE: A German transplant center recently published a prognostic model predicting graft function one year after deceased donor kidney transplantation (KTx) relying on pre-transplant variables. The aim of this study is to externally validate this model. METHODS: We retrospectively analyzed clinical data from deceased donor KTx recipients undergoing transplantation between January 2007 and December 2023 at University Hospital Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen. Receiver operating characteristics (ROC) curves were analyzed to validate the prognostic model based on donor age, donor serum creatinine, recipient body mass index, re-transplantation > 2nd KTx, and cold ischemia time. Glomerular filtration rates were categorized using the Kidney Disease: Improving Global Outcomes (KDIGO) categories G1 - G5. RESULTS: . A validation for all eGFR categories was only possible with recalibration of the constant and coefficients of the original model, whereas without recalibration it could only be validated for KDIGO G2 and G4. Unfavourable recipient/donor-pairings with eGFR categories G4 and G5 one year after KTx could be predicted with an area under the ROC curve (AUC) > 0.700 in the validation and the original study cohort. CONCLUSION: We successfully validated the prognostic model for prediction of eGFR categories G4 and G5, which is of high clinical importance to identify outcomes with marginal graft function one year after KTx, thereby facilitating the avoidance of futile recipient/donor-pairings during allocation.

Authors 14

1. Philipp Tessmer corresponding Aachen Department of General, Visceral Pediatric and Transplant Surgery

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Department of General, Visceral, Pediatric and Transplant Surgery, University Hospital RWTH Aachen, Aachen, Germany. ptessmer@ukaachen.de

2. Clara A. Weigle Aachen Department of General, Visceral Pediatric and Transplant Surgery

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Department of General, Visceral, Pediatric and Transplant Surgery, University Hospital RWTH Aachen, Aachen, Germany

3. F. Meister Aachen Department of General, Visceral Pediatric and Transplant Surgery

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Department of General, Visceral, Pediatric and Transplant Surgery, University Hospital RWTH Aachen, Aachen, Germany

4. Bengt Arne Wiemann Aachen Department of General, Visceral Pediatric and Transplant Surgery

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Department of General, Visceral, Pediatric and Transplant Surgery, University Hospital RWTH Aachen, Aachen, Germany

5. Wilfried Gwinner

   Medizinische Hochschule Hannover

   Affiliation as printed

   Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany

6. Anja M€uhlfeld Aachen Division of Nephrology and Immunology

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Division of Nephrology and Immunology, University Hospital RWTH Aachen, Aachen, Germany

7. Rafael Kramann Aachen Division of Nephrology and Immunology

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Division of Nephrology and Immunology, University Hospital RWTH Aachen, Aachen, Germany

8. Dennis Kleine-Döpke

   Medizinische Hochschule Hannover

   Affiliation as printed

   Department of General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany

9. Nicolas Richter

   Medizinische Hochschule Hannover

   Affiliation as printed

   Department of General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany

10. Felix Oldhafer Aachen Department of General, Visceral Pediatric and Transplant Surgery

    Universitätsklinikum Aachen · RWTH Aachen University

    Affiliation as printed

    Department of General, Visceral, Pediatric and Transplant Surgery, University Hospital RWTH Aachen, Aachen, Germany

11. Florian W. R. Vondran Aachen Department of General, Visceral Pediatric and Transplant Surgery

    Universitätsklinikum Aachen · RWTH Aachen University

    Affiliation as printed

    Department of General, Visceral, Pediatric and Transplant Surgery, University Hospital RWTH Aachen, Aachen, Germany

12. Harald Schrem

    Klinikum Chemnitz

    Affiliation as printed

    Department of General and Visceral Surgery, Klinikum Chemnitz, Chemnitz, Germany

13. Oliver Beetz Aachen Department of General, Visceral Pediatric and Transplant Surgery

    Universitätsklinikum Aachen · RWTH Aachen University

    Affiliation as printed

    Department of General, Visceral, Pediatric and Transplant Surgery, University Hospital RWTH Aachen, Aachen, Germany

14. Ulrich Zwirner

    Medizinische Hochschule Hannover

    Affiliation as printed

    Department of General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany