title: Living donor risk model for predicting kidney allograft and patient survival in an emerging economy.
abstract: OBJECTIVE
  Living donor kidney is the main source of donor organs in low to middle income countries. We aimed to develop a living donor risk model that predicts graft and patient survival in an emerging economy.
  
  
  METHODS
  We used data from the Sindh Institute of Urology and Transplantation (SIUT) database (n = 2283 recipients and n = 2283 living kidney donors, transplanted between 1993 and 2009) and conducted Cox proportional hazard analyses to develop a composite score that predicts graft and patient survivals.
  
  
  RESULTS
  Donor factors age, creatinine clearance, nephron dose (estimated by donor/recipient body weight ratio) and human leukocyte antigen (HLA) match were included in the living donor risk model. The adjusted hazard ratios (HRs) for graft failures among those who received a kidney with living donor scores (reference to donor score of zero) of 1, 2, 3 and 4 were 1.14 (95%CI: 0.94-1.39), 1.24 (95%CI:1.03-1.49), 1.25 (95%CI:1.03-1.51) and 1.36 (95%CI:1.08-1.72) (P-value for trend =0.05). Similar findings were observed for patient survival.
  
  
  CONCLUSIONS
  Similar to findings in high income countries, our study suggests that donor characteristics such as age, nephron dose, creatinine clearance and HLA match are important factors that determine the long-term patient and graft survival in low income countries. However, other crucial but undefined factors may play a role in determining the overall risk of graft failure and mortality in living kidney donor transplant recipients.
authors.affiliation: Department of Pathology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan.
authors.forename: Mirza Naqi
authors.initials: MN
authors.lastname: Zafar
authors.affiliation: Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Germaine
authors.initials: G
authors.lastname: Wong
authors.affiliation: Department of Nephrology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan.
authors.forename: Tahir
authors.initials: T
authors.lastname: Aziz
authors.affiliation: Department of Pathology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan.
authors.forename: Khawar
authors.initials: K
authors.lastname: Abbas
authors.affiliation: Department of Urology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan.
authors.forename: S
authors.initials: S
authors.lastname: Adibul Hasan Rizvi
mesh_terms: D000293:Adolescent; D000328:Adult; D064591:Allografts; D016208:Databases, Factual; D003661:Decision Support Techniques; D003906:Developing Countries / Q000191:economics*; D046148:Donor Selection; D005260:Female; D006085:Graft Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010154:Pakistan / Q000453:epidemiology; D011183:Postoperative Complications / Q000401:mortality; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: graft survival; kidney transplantation; living donor; patient; risk model