title: Identification of the optimal donor quality scoring system and measure of early renal function in kidney transplantation.
abstract: BACKGROUND
  The early identification of kidney allografts at risk of later dysfunction has implications for clinical practice. Donor quality scoring systems (preoperative) and measures of early allograft function (first week postoperative) have previously shown practical utility. This study aimed to determine the optimal parameter(s) (preoperative and postoperative) with greatest predictive power for the development of subsequent allograft dysfunction.
  
  
  METHODS
  Consecutive deceased donor renal transplants (n=217) were studied. In each, the following measures were assessed: Preoperative donor quality scores: expanded criteria donor status; Deceased Donor Score (Nyberg et al., Am J Transplant 2003;3:715); Donor Risk Score (Schold et al., Am J Transplant 2005; 5(4 pt 1): 757); and delayed graft function (DGF) Nomogram (Irish et al., J Am Soc Nephrol 2003; 14: 2967). Postoperative early function measures: dialysis requirement and duration; extended DGF definition (Boom et al., Kidney Int 2000; 58: 859); creatinine at day 5 and day 7; creatinine reduction ratios at day 2 and day 7; and urine output posttransplantation. Primary outcome measures were creatinine at 12 months and the development of chronic kidney disease stage 4T.
  
  
  RESULTS
  Of donor scoring systems, Donor Risk Score was best associated with subsequent allograft function. Of early function measures: the extended definition of DGF, creatinine at day 5, and dialysis duration showed greatest predictive power in the patient population overall, those not requiring postoperative dialysis, and those requiring dialysis, respectively. No scores or early function measures were associated with change in creatinine between 6 and 12 months.
  
  
  CONCLUSIONS
  This study validates and identifies the optimal early predictive parameter available for kidney transplant recipients, with implications for refining early postoperative management and potential utility in organ allocation policy.
authors.affiliation: Renal Institute of Birmingham, University Hospital Birmingham, Birmingham, United Kingdom.
authors.forename: Jason
authors.initials: J
authors.lastname: Moore
authors.forename: Satish
authors.initials: S
authors.lastname: Ramakrishna
authors.forename: Kay
authors.initials: K
authors.lastname: Tan
authors.forename: Paul
authors.initials: P
authors.lastname: Cockwell
authors.forename: Kevin
authors.initials: K
authors.lastname: Eardley
authors.forename: Mark A
authors.initials: MA
authors.lastname: Little
authors.forename: Paul
authors.initials: P
authors.lastname: Rylance
authors.forename: Kunigal
authors.initials: K
authors.lastname: Shivakumar
authors.forename: Vijayan
authors.initials: V
authors.lastname: Suresh
authors.forename: Kerry
authors.initials: K
authors.lastname: Tomlinson
authors.forename: Andrew
authors.initials: A
authors.lastname: Ready
authors.forename: Richard
authors.initials: R
authors.lastname: Borrows
mesh_terms: D000328:Adult; D002102:Cadaver; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival / Q000502:physiology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007668:Kidney / Q000502:physiology*; D007677:Kidney Function Tests; D016030:Kidney Transplantation / Q000276:immunology / Q000502:physiology*; D008297:Male; D018579:Patient Selection; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D014019:Tissue Donors / Q000706:statistics & numerical data*; D014184:Transplantation, Homologous; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents