Development and validation of a prognostic model for kidney function 1 year after combined pancreas and kidney transplantation using pre-transplant donor and recipient variables

Abstract

PurposeThe widening gap between demand and supply of organs for transplantation provides extraordinary challenges for ethical donor organ allocation rules. The transplant community is forced to define favorable recipient/donor combinations for simultaneous kidney-pancreas transplantation. The aim of this study is the development of a prognostic model for the prediction of kidney function 1 year after simultaneous pancreas and kidney transplantation using pre-transplant donor and recipient variables with subsequent internal and external validation.MethodsIncluded were patients with end-stage renal failure due to diabetic nephropathy. Multivariable logistic regression modeling was applied for prognostic model design with retrospective data from Hannover Medical School, Germany (01.01.2000–31.12.2011) followed by prospective internal validation (01 Jan. 2012–31 Dec. 2015). Retrospective data from another German transplant center in Kiel was retrieved for external model validation via the initially derived logit link function.ResultsThe developed prognostic model is able to predict kidney graft function 1 year after transplantation ≥ KDIGO stage III with high areas under the receiver operating characteristic curve in the development cohort (0.943) as well as the internal (0.807) and external validation cohorts (0.784).ConclusionThe proposed validated model is a valuable tool to optimize present allocation rules with the goal to prevent transplant futility. It might be used to support donor organ acceptance decisions for individual recipients.Electronic supplementary materialThe online version of this article (10.1007/s00423-018-1712-z) contains supplementary material, which is available to authorized users.

Invited commentary: advantages and cautions for developing valid prognostic models of simultaneous pancreas and kidney transplantation outcomes

“…By invitation from the Editor in Chief, we wish to comment on the article, BDevelopment and validation of a prognostic model for kidney function one year after combined pancreas and kidney transplantation using pre-transplant donor and recipient variables,^by Zorn et al [1]. In their article, Zorn et al presented a prognostic model for the prediction of kidney function 1 year after simultaneous pancreas and kidney transplantation (SPKT) using pre-transplant donor and recipient variables.…”