Comparison of Clinical Outcomes Among Deceased Donor Kidney Transplant Recipients Before and After Utilizing Estimated Posttransplant Survival Score for Kidneys Allocation in Malaysia |
| |
| Affiliation: | 1. Department of Nephrology, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia;2. Department of Nephrology, Selayang Hospital, Selangor, Malaysia;1. Department of Urology, Dokkyo Medical University Saitama Medical Center, Koshigaya City, Saitama, Japan;2. Transplant Center, Dokkyo Medical University Saitama Medical Center, Koshigaya City, Saitama, Japan;3. Department of Pathology, Dokkyo Medical University Saitama Medical Center, Koshigaya City, Saitama, Japan;4. Division of Transplant Surgery, Tokyo Metropolitan Health and Hospitals Corporation Ohkubo Hospital, Shinjuku Ward, Tokyo, Japan;5. Department of Nephrology, Dokkyo Medical University Saitama Medical Center, Koshigaya City, Saitama, Japan;1. Department of Cardiovascular Surgery, Teikyo University, Tokyo, Japan;2. Department of Medicine, Emory University, Atlanta, Georgia;3. Department of Surgery, Teikyo University, Tokyo, Japan;1. Division of Nephrology, Department of Internal Medicine, Leesin Hemodialysis and Intervention Clinic, Busan, South Korea;2. Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University College of Medicine, Incheon, South Korea;1. Department of Surgery, Tohoku University Graduate School of Medicine, Miyagi, Japan;2. Department of Hepato-Biliary Pancreatic/Transplantation Surgery, Asahikawa Medical University, Hokkaido, Japan;1. Department of Urology, Tokyo Women''s Medical University, Tokyo;2. Department of Organ Transplant Medicine, Tokyo Women''s Medical University, Tokyo;3. Department of Pediatric Nephrology, Tokyo Women''s Medical University, Tokyo, Japan |
| |
| Abstract: | Background. The Malaysian Kidney Allocation System implemented in 2020 includes only kidney transplant candidates with estimated posttransplant survival (EPTS) score of ≤20%, in replacement of Malaysian Organs Sharing System, which was based solely on dialysis vintage. We aim to compare the clinical outcomes of deceased-donor kidney transplant recipients (DDKTRs) with EPTS ≤20% to those with EPTS >20%.Methods. All DDKTRs between January 1, 2015, and December 29, 2020, were included and categorized into 2 groups: EPTS ≤20% and EPTS >20%. Cox regression was performed to evaluate the association of EPTS score and patient survival. The rate of postoperative complications, graft failure and patient survival were compared between 2 groups. Data were analyzed with SPSS v26 and R v4.0.4. The study complies with the Helsinki Congress and the Istanbul Declaration.Results. We included 159 DDKTRs, with a median follow-up of 25 months (range, 10-60 months). The mean age of those with EPTS ≤20% was 32.2 ± 3.4 years and those with EPTS >20% was 46.0 ± 6.7 years, and the median EPTS score were 16% (range, 12%-18%) and 38% (range, 27%-56.5%), respectively. EPTS score was associated with patient survival (hazard ratio, 1.031; 95% CI 1.010-1.052; P = .003), and the cutoff points of 30% and above were associated with worse survival. It showed good discrimination (C-index, 0.729; 95% CI 0.579-0.878; P = .003) and the optimal cutoff value was 38% (65.5% sensitivity, 68.8% specificity, 17.8% positive predictive value, and 95.8% negative predictive value). Both groups had similar rate of surgical complications (P = .191), graft failure (P = .503), and patient survival (P = .654), but those with EPTS >20% had higher incidence of urinary tract infection (9.3% vs 27.6%, P = .016).Conclusions. There was no difference in clinical outcomes using an EPTS cutoff point of 20% but worse patient survival if higher cutoff point was used. |
| |
| Keywords: | |
| 本文献已被 ScienceDirect 等数据库收录！ |
|
