title: A clinical tool to risk stratify potential kidney transplant recipients and predict severe adverse events.
abstract: Preoperative risk assessment of potential kidney transplant recipients often fails to adequately balance risk related to underlying comorbidities with the beneficial impact of kidney transplantation. We sought to develop a simple scoring system based on factors known at the time of patient assessment for placement on the waitlist to predict likelihood of severe adverse events 1 year post-transplant. The tool includes four components: age, cardiopulmonary factors, functional status, and metabolic factors. Pre-transplant factors strongly associated with severe adverse events include diabetic (OR: 3.76, P<.001), coronary artery disease (OR: 3.45, P<.001), history of CABG/PCI (OR 3.1, P=.001), and peripheral vascular disease (OR 2.74, P=.008).The score was evaluated by calculation of concordance index. The C statistic of 0.74 for the risk stratification group was considered good discrimination in the validation cohort (N=127) compared to the development cohort (N=368). The pre-transplant risk group was highly predictive of severe adverse events (OR 2.36, P<.001). Patients stratified into the above average-risk group were four times more likely to experience severe adverse events compared to average-risk patients, while patients in the high-risk group were nearly 11 times more likely to experience severe adverse events. The pre-transplant risk stratification tool is a simple scoring scheme using easily obtained preoperative characteristics that can meaningfully stratify patients in terms of post-transplant risk and may ultimately guide patient selection and inform the counseling of potential kidney transplant recipients.
authors.affiliation: Department of Surgery, Hennepin County Medical Center, Minneapolis, MN, USA.
authors.forename: Rachel M
authors.initials: RM
authors.lastname: Nygaard
authors.affiliation: Department of Surgery, Hennepin County Medical Center, Minneapolis, MN, USA.
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Sirany
authors.affiliation: Department of Surgery, Hennepin County Medical Center, Minneapolis, MN, USA.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Wyman
authors.affiliation: Transplant Clinic, Hennepin County Medical Center, Minneapolis, MN, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Bodner
authors.affiliation: Department of Surgery, Hennepin County Medical Center, Minneapolis, MN, USA.
authors.forename: Chad J
authors.initials: CJ
authors.lastname: Richardson
authors.affiliation: Department of Surgery, Hennepin County Medical Center, Minneapolis, MN, USA.
authors.forename: Arthur L
authors.initials: AL
authors.lastname: Ney
authors.affiliation: Department of Surgery, Hennepin County Medical Center, Minneapolis, MN, USA.
authors.forename: Mark D
authors.initials: MD
authors.lastname: Odland
authors.affiliation: Department of Surgery, Hennepin County Medical Center, Minneapolis, MN, USA. mark.hill@hcmed.org.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Hill
mesh_terms: D000328:Adult; D000368:Aged; D003661:Decision Support Techniques; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D016030:Kidney Transplantation; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis* / Q000209:etiology; D011897:Random Allocation; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors
keywords: adverse event; age; cardiovascular; clinical tool; functional status; graft survival; kidney transplant; metabolic; outcome; recipient selection; renal transplant; risk stratify