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Patient Functional Status at Transplant and Its Impact on Posttransplant Survival of Adult Deceased-donor Kidney Recipients

Bui, Kevin, MS1,2; Kilambi, Vikram, PhD3; Rodrigue, James R., PhD4; Mehrotra, Sanjay, PhD1,2,5

doi: 10.1097/TP.0000000000002397
Original Clinical Science—General

Background. Recorded at the time of transplant and reported to the Organ Procurement and Transplantation Network, patient’s functional status is measured using the Karnofsky performance score (KPS), ranging 0 to 100. Functional status analysis may provide insights on candidate listing and posttransplant survival outcomes for deceased-donor kidney transplants.

Methods. The cohort consisted of adult deceased-donor kidney transplant recipients transplanted beginning January 2007. One-year and 3-year Cox models for posttransplant survival were fitted with current Scientific Registry of Transplant Recipients (SRTR) variables and KPS. Comparative analyses were performed between the SRTR model without KPS and augmented model with it. Using the augmented model, we examined the impact of Kidney Donor Profile Index on posttransplant survivals for 5 different KPS strata: 10 to 30, 40 to 50, 60 to 70, 80 to 90, and 100.

Results. Comparative analyses showed that KPS was a statistically significant predictor for posttransplant survival: it improved model calibration, discrimination, and predictive accuracy. From the augmented model, the survival curves illustrated that recipients with KPS 40 to 50 and kidneys with Kidney Donor Profile Index as high as 99 have expected survival probabilities of above 90% in 1 year and above 80% in 3 years. The expected survival probabilities improve as KPS increases. Recipients with KPS 10 to 30 have the worst survival probability, even if they received high-quality kidneys.

Conclusions. Insights from the survival analyses recommend possible inclusion of functional status into SRTR’s risk-adjusted models. Moreover, they invite further examination of its use to improve current listing and transplantation strategies at transplant centers and potentially reduce deceased-donor kidney discard rate.

1 Industrial Engineering and Management Sciences, Northwestern University, Evanston, IL.

2 Center for Engineering and Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.

3 RAND Corporation, Boston, MA.

4 Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.

5 Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, IL.

Received 7 June 2018. Revision received 13 July 2018.

Accepted 30 July 2018.

The authors declare no conflicts of interest.

This work is funded by National Institutes for Health award 1R21DK108104-01.

Supplemental digital content (SDC) is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (

Correspondence: Sanjay Mehrotra, PhD, Industrial Engineering and Management Sciences, 2145 Sheridan Rd, Tech C246, Evanston, IL 60208. (

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