title: Predicting 5-year risk of kidney transplant failure: a prediction instrument using data available at 1 year posttransplantation.
abstract: BACKGROUND
  Accurate prediction of kidney transplant failure remains imperfect. The objective of this study was to develop and validate risk scores predicting 5-year transplant failure, based on data available 12 months posttransplantation.
  
  
  METHODS
  Development and then independent multicenter validation of risk scores predicting death-censored and overall transplant failure.
  
  
  METHODS
  Outcomes of kidney transplant recipients (n=651) alive with transplant function 12 months posttransplantation in Birmingham, United Kingdom, were used to develop models predicting transplant failure risk 5 years posttransplantation. The resulting risk scores were evaluated for prognostic utility (discrimination, calibration, and risk reclassification) in independent cohorts from Tours, France (n=736); Leeds, United Kingdom (n=787); and Halifax, Canada (n=475).
  
  
  METHODS
  Weighted regression coefficients for baseline and 12-month demographic and clinical predictor characteristics.
  
  
  RESULTS
  Death-censored and overall transplant failure 5 years posttransplantation.
  
  
  METHODS
  Baseline data and time to transplant failure.
  
  
  RESULTS
  Following model development, variables included in separate scores for death-censored and overall transplant failure included recipient age, sex, and race; acute rejection; transplant function; serum albumin level; and proteinuria. In the validation cohorts, these scores showed good to excellent discrimination for death-censored transplant failure (C statistics, 0.78-0.90) and moderate to good discrimination for overall transplant failure (C statistics, 0.75-0.81). Both scores demonstrated good calibration (Hosmer-Lemeshow P>0.05 in all cohorts). Compared with estimated glomerular filtration rate in isolation, application of the scores resulted in statistically significant and clinically relevant risk reclassification for death-censored transplant failure (net reclassification improvement [NRI], 36.1%-83.0%; all P<0.001) and overall transplant failure (NRI, 38.7%-53.5%; all P<0.001). Compared with the previously described US Renal Data System-based risk calculator, significant and relevant risk reclassification for overall transplant failure was seen (NRI, 30.0%; P<0.001).
  
  
  CONCLUSIONS
  Validation is required in further populations.
  
  
  CONCLUSIONS
  These validated risk scores may be of prognostic utility in kidney transplantation, accurately identifying at-risk transplants, and informing clinicians and patients.
authors.affiliation: Department of Nephrology, Queen Elizabeth Hospital, Birmingham, United Kingdom.
authors.forename: Shazia
authors.initials: S
authors.lastname: Shabir
authors.affiliation: Service de Néphrologie-Immunologie clinique, CHU Tours, Tours, France.
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Halimi
authors.affiliation: Renal Transplant Unit, University of Leeds, Leeds, United Kingdom.
authors.forename: Aravind
authors.initials: A
authors.lastname: Cherukuri
authors.affiliation: Department of Nephrology, Queen Elizabeth Hospital, Birmingham, United Kingdom.
authors.forename: Simon
authors.initials: S
authors.lastname: Ball
authors.affiliation: Department of Nephrology, Queen Elizabeth Hospital, Birmingham, United Kingdom.
authors.forename: Charles
authors.initials: C
authors.lastname: Ferro
authors.affiliation: Department of Nephrology, Queen Elizabeth Hospital, Birmingham, United Kingdom.
authors.forename: Graham
authors.initials: G
authors.lastname: Lipkin
authors.affiliation: Department of Nephrology, Queen Elizabeth Hospital, Birmingham, United Kingdom.
authors.forename: David
authors.initials: D
authors.lastname: Benavente
authors.affiliation: Service de Néphrologie-Immunologie clinique, CHU Tours, Tours, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Gatault
authors.affiliation: Renal Transplant Unit, University of Leeds, Leeds, United Kingdom.
authors.forename: Richard
authors.initials: R
authors.lastname: Baker
authors.affiliation: Division of Nephrology, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: Bryce
authors.initials: B
authors.lastname: Kiberd
authors.affiliation: Department of Nephrology, Queen Elizabeth Hospital, Birmingham, United Kingdom; Centre for Translational Inflammation Research, University of Birmingham, Birmingham, United Kingdom. Electronic address: richard.borrows@uhb.nhs.uk.
authors.forename: Richard
authors.initials: R
authors.lastname: Borrows
mesh_terms: D000328:Adult; D005260:Female; D005919:Glomerular Filtration Rate; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D011379:Prognosis; D015203:Reproducibility of Results; D018570:Risk Assessment; D016896:Treatment Outcome
keywords: Kidney; risk score; transplant