title: External validation of the estimated posttransplant survival score for allocation of deceased donor kidneys in the United States.
abstract: The US kidney allocation system adopted in 2013 will allocate the best 20% of deceased donor kidneys (based on the kidney donor risk index [KDRI]) to the 20% of waitlisted patients with the highest estimated posttransplant survival (EPTS). The EPTS has not been externally validated, raising concerns as to its suitability to discriminate between kidney transplant candidates. We examined EPTS using data from the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry. We included 4983 adult kidney-only deceased donor transplants over 2000-2011. We constructed three Cox models for patient survival: (i) EPTS alone; (ii) EPTS plus donor age, hypertension and HLA-DR mismatch; and (iii) EPTS plus log(KDRI). All models demonstrated moderately good discrimination, with Harrell's C statistics of 0.67, 0.68 and 0.69, respectively. These results are virtually identical to the internal validation that demonstrated a c-statistic of 0.69. These results provide external validation of the EPTS as a moderately good tool for discriminating posttransplant survival of adult kidney-only transplant recipients.
authors.affiliation: Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, Adelaide, SA, Australia; Department of Transplantation, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia.
authors.forename: P A
authors.initials: PA
authors.lastname: Clayton
authors.forename: S P
authors.initials: SP
authors.lastname: McDonald
authors.forename: J J
authors.initials: JJ
authors.lastname: Snyder
authors.forename: N
authors.initials: N
authors.lastname: Salkowski
authors.forename: S J
authors.initials: SJ
authors.lastname: Chadban
mesh_terms: D000328:Adult; D000367:Age Factors; D000465:Algorithms; D001315:Australia; D005260:Female; D005500:Follow-Up Studies; D006684:HLA-DR Antigens / Q000276:immunology; D006801:Humans; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D009520:New Zealand; D016016:Proportional Hazards Models; D012042:Registries; D051437:Renal Insufficiency / Q000401:mortality / Q000601:surgery*; D014019:Tissue Donors; D016896:Treatment Outcome; D014481:United States
chemical_list: D006684:HLA-DR Antigens
keywords: Deceased donor; kidney allocation; kidney transplantation; patient survival