Kidney360 · 2025
External Validation of the Kidney Donor Profile Index to Predict Long-Term Graft Survival in Kidney Transplant Recipients.
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Cassão Bianca, Foresto Renato D, Hazin Maria Amélia, Morais Ana Paula, de Andrade Luis Gustavo Modelli, Medina-Pestana José, Requião-Moura Lúcio, Tedesco-Silva Helio
Аннотация
KEY POINTS: The first transportability study to externally validate kidney donor profile index as a predictive index for long-term graft survival in kidney transplant recipients. Validation using a large sample from a center of high transplantation activity representative of country with peculiar demographic characteristics. Calibrated finds that can guide organ allocation and inform clinical decisions.
BACKGROUND: The kidney donor profile index (KDPI), developed in the United States, is widely used to predict graft failure after kidney transplantation. However, external validation is crucial to assess its performance in other populations. This study aimed to validate KDPI in Brazilian kidney transplant recipients.
METHODS: We conducted a single-center, retrospective cohort study involving 1807 recipients of deceased-donor kidney transplants performed between January 2013 and December 2015, with a 5-year follow-up. The model's discrimination, overall fitness, and calibration were assessed in predicting graft failure.
RESULTS: Recipients were 49.2 years, and 60.8% were male, on hemodialysis for 40.1 months. The median kidney donor risk index and KDPI were 1.2 and 69%, respectively. The area under the receiver operating characteristic curve for graft survival was highest in the KDPI >85% category (0.576 [95% confidence interval (CI), 0.521 to 0.631]), followed by the >35%–85% (0.504 [95% CI, 0.460 to 0.549]) and the 0%–35% (0.488 [95% CI, 0.408 to 0.568]) categories. Discrimination improved in the Cox model incorporating recipient variables and KDPI categories (0.801 [95% CI, 0.775 to 0.827]). The KDPI as a continuous variable had a C-index of 0.561 (95% CI, 0.533 to 0.588), similar to donor age alone (0.560 [95% CI, 0.534 to 0.587]). The overall fitness assessed by the Brier score was 0.151, and the calibration plot showed a good performance for KDPI. However, it was similar to what was observed using the donor age as a predictor isolated (0.152).
CONCLUSIONS: In this transportability external validation study, KDPI performed acceptably as a prediction tool for 5-year graft survival after kidney transplantation. These findings guide organ allocation and support clinical decision making regarding organ acceptance.
BACKGROUND: The kidney donor profile index (KDPI), developed in the United States, is widely used to predict graft failure after kidney transplantation. However, external validation is crucial to assess its performance in other populations. This study aimed to validate KDPI in Brazilian kidney transplant recipients.
METHODS: We conducted a single-center, retrospective cohort study involving 1807 recipients of deceased-donor kidney transplants performed between January 2013 and December 2015, with a 5-year follow-up. The model's discrimination, overall fitness, and calibration were assessed in predicting graft failure.
RESULTS: Recipients were 49.2 years, and 60.8% were male, on hemodialysis for 40.1 months. The median kidney donor risk index and KDPI were 1.2 and 69%, respectively. The area under the receiver operating characteristic curve for graft survival was highest in the KDPI >85% category (0.576 [95% confidence interval (CI), 0.521 to 0.631]), followed by the >35%–85% (0.504 [95% CI, 0.460 to 0.549]) and the 0%–35% (0.488 [95% CI, 0.408 to 0.568]) categories. Discrimination improved in the Cox model incorporating recipient variables and KDPI categories (0.801 [95% CI, 0.775 to 0.827]). The KDPI as a continuous variable had a C-index of 0.561 (95% CI, 0.533 to 0.588), similar to donor age alone (0.560 [95% CI, 0.534 to 0.587]). The overall fitness assessed by the Brier score was 0.151, and the calibration plot showed a good performance for KDPI. However, it was similar to what was observed using the donor age as a predictor isolated (0.152).
CONCLUSIONS: In this transportability external validation study, KDPI performed acceptably as a prediction tool for 5-year graft survival after kidney transplantation. These findings guide organ allocation and support clinical decision making regarding organ acceptance.