title: The Kidney Transplant Morbidity Index (KTMI): a simple prognostic tool to help determine outcome risk in kidney transplant candidates.
abstract: BACKGROUND
  The Kidney Transplant Morbidity Index (KTMI) is a novel prognostic morbidity index to help determine the impact that pretransplant comorbid conditions have on transplant outcome.
  
  
  OBJECTIVE
  To use national data to validate the KTMI.
  
  
  METHODS
  Retrospective analysis of the Organ Procurement and Transplant Network/United Network for Organ Sharing database.
  
  
  METHODS
  The study sample consisted of 100 261 adult patients who received a kidney transplant between 2000 and 2008.
  
  
  METHODS
  Kaplan-Meier survival curves were used to demonstrate 3-year graft and patient survival for each KTMI score. Cox proportional hazards regression models were created to determine hazards for 3-year graft failure and patient mortality for each KTMI score.
  
  
  RESULTS
  A sequential decrease in graft survival (0 = 91.2%, 1 = 88.2%, 2 = 85.4%, 3 = 81.7%, 4 = 77.8%, 5 = 74.0%, 6 = 69.8%, and ≥ 7 = 68.7) and patient survival (0 = 98.2%, 1 = 96.6%, 2 = 93.7%, 3 = 89.7%, 4 = 84.8%, 5 = 80.8%, 6 = 76.0%, and ≥ 7 = 74.7%) is seen as KTMI scores increase. The differences in graft and patient survival between KTMI scores are all significant (P< .001) except between 6 and ≥ 7. Multivariate regression analysis reveals that KTMI is an independent predictor of higher graft failure and patient mortality rates and that risk increases as KTMI scores increase.
  
  
  CONCLUSIONS
  The KTMI strongly predicts graft and patient survival by using pretransplant comorbid conditions; therefore, this easy-to-use tool can aid in determining outcome risk and transplant candidacy before listing, particularly in candidates with multiple comorbid conditions.
authors.affiliation: Robert Wood Johnson University Hospital.
authors.forename: Daniel
authors.initials: D
authors.lastname: Pieloch
authors.affiliation: Medical School, New Brunswick, New Jersey.
authors.forename: Viktor
authors.initials: V
authors.lastname: Dombrovskiy
authors.affiliation: Robert Wood Johnson University Hospital Medical School, New Brunswick, New Jersey.
authors.forename: Adena J
authors.initials: AJ
authors.lastname: Osband
authors.affiliation: Robert Wood Johnson University Hospital Medical School, New Brunswick, New Jersey.
authors.forename: Meelie
authors.initials: M
authors.lastname: DebRoy
authors.affiliation: Robert Wood Johnson University Hospital Medical School, New Brunswick, New Jersey.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Mann
authors.affiliation: Robert Wood Johnson University Hospital Medical School, New Brunswick, New Jersey.
authors.forename: Sonalis
authors.initials: S
authors.lastname: Fernandez
authors.affiliation: Robert Wood Johnson University Hospital Medical School, New Brunswick, New Jersey.
authors.forename: Zahidul
authors.initials: Z
authors.lastname: Mondal
authors.affiliation: Robert Wood Johnson University Hospital Medical School, New Brunswick, New Jersey.
authors.forename: David A
authors.initials: DA
authors.lastname: Laskow
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015897:Comorbidity; D005260:Female; D006084:Graft Rejection; D006801:Humans; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D011379:Prognosis; D012189:Retrospective Studies; D012306:Risk; D018570:Risk Assessment