Patient survival scale after kidney transplant from deceased donors in Veracruz, Mexico

Authors

  • Gustavo Martínez-Mier <p>Instituto Mexicano del Seguro Social, Centro M&eacute;dico Nacional &ldquo;Adolfo Ruiz Cortines&rdquo;, Hospital de Especialidades No. 14, Servicio de Cirug&iacute;a de Trasplantes. Veracruz, Veracruz</p>
  • Ernesto Soto-Miranda <p>Instituto Mexicano del Seguro Social, Centro M&eacute;dico Nacional &ldquo;Adolfo Ruiz Cortines&rdquo;, Hospital de Especialidades No. 14, Servicio de Cirug&iacute;a de Trasplantes. Veracruz, Veracruz</p>
  • Pedro Iván Moreno-Ley <p>Instituto Mexicano del Seguro Social, Centro M&eacute;dico Nacional &ldquo;Adolfo Ruiz Cortines&rdquo;, Hospital de Especialidades No. 14, Servicio de Cirug&iacute;a de Trasplantes. Veracruz, Veracruz</p>
  • Marco Tulio Méndez-López <p>Instituto Mexicano del Seguro Social, Centro M&eacute;dico Nacional &ldquo;Adolfo Ruiz Cortines&rdquo;, Hospital de Especialidades No. 14, Servicio de Cirug&iacute;a de Trasplantes. Veracruz, Veracruz</p>
  • Luis Filadelfo Budar-Fernández <p>Instituto Mexicano del Seguro Social, Centro M&eacute;dico Nacional &ldquo;Adolfo Ruiz Cortines&rdquo;, Hospital de Especialidades No. 14, Servicio de Cirug&iacute;a de Trasplantes. Veracruz, Veracruz</p>
  • Sandro Fabricio Ávila-Pardo <p>Instituto Mexicano del Seguro Social, Centro M&eacute;dico Nacional &ldquo;Adolfo Ruiz Cortines&rdquo;, Hospital de Especialidades No. 14, Servicio de Cirug&iacute;a de Trasplantes. Veracruz, Veracruz</p>
  • Edgar Guadalupe Aguilar-Sandoval <p>Instituto Mexicano del Seguro Social, Centro M&eacute;dico Nacional &ldquo;Adolfo Ruiz Cortines&rdquo;, Hospital de Especialidades No. 14, Servicio de Cirug&iacute;a de Trasplantes. Veracruz, Veracruz</p>
  • Stefan Zilli-Hernández <p>Instituto Mexicano del Seguro Social, Centro M&eacute;dico Nacional &ldquo;Adolfo Ruiz Cortines&rdquo;, Hospital de Especialidades No. 14, Servicio de Cirug&iacute;a de Trasplantes. Veracruz, Veracruz</p>
  • Francisco Lajud-Barquín <p>Instituto Mexicano del Seguro Social, Centro M&eacute;dico Nacional &ldquo;Adolfo Ruiz Cortines&rdquo;, Hospital de Especialidades No. 14, Servicio de Cirug&iacute;a de Trasplantes. Veracruz, Veracruz</p>
  • Lucia Vega-Rojano <p>Instituto Mexicano del Seguro Social, Centro M&eacute;dico Nacional &ldquo;Adolfo Ruiz Cortines&rdquo;, Hospital de Especialidades No. 14, Servicio de Cirug&iacute;a de Trasplantes. Veracruz, Veracruz</p>
  • Geovanna Coello-Torres <p>Instituto Mexicano del Seguro Social, Centro M&eacute;dico Nacional &ldquo;Adolfo Ruiz Cortines&rdquo;, Hospital de Especialidades No. 14, Servicio de Cirug&iacute;a de Trasplantes. Veracruz, Veracruz</p>

Keywords:

Tissue Donors, Kidney Transplantation, Survival Rate, Mexico, /mortality

Abstract

Background: The Estimated Post Transplant Survival (EPTS) score is calculated based on age, the presence of diabetes mellitus, years on dialysis, and prior organ transplant. The EPTS score has been validated in other countries.

Objective: To apply and assess the EPTS score in our population of deceased-donor kidney transplants.

Materials and methods: Retrospective study of adult deceased-donor kidney transplants from January, 2003, to December, 2016. For the statistical analysis it was used Spearman’s correlation, receiver-operator curves (ROC) and Kaplan-Meier curves. A p value < 0.05 was considered statistically significant.

Results: 176 adult deceased-donor kidney transplants were included. Medium age was 34.7 ± 11 years; 53.4% were men, 4% diabetics; mean dialysis time was 5.5 ± 3.9 years and 4% had a prior organ transplant. The medium of EPTS score was 16.3 ± 18.7 (1‑94). Spearman’s correlation was −0.394 (p = 0.0001). C value (ROC) was 0.64 ± 0.6 (95% CI, 0.52-0.75) (p = 0.011). Medium survival calculated with Kaplan-Meier in patients with an EPTS score < 20, was 10.2 ± 0.3 years (95% CI, 9.5-10.9) versus patients with EPTS score > 20: 7.03 ± 0.9 years (95% CI, 5.1-8.9) (p = 0.001). Each 20% increase of EPTS, patient survival time diminished (p = 0.0001).

Conclusions: The EPTS score is a useful tool for establishing survival in adult Mexican recipients of deceased-donor kidney transplants.

Downloads

Download data is not yet available.

Author Biographies

  • Gustavo Martínez-Mier, <p>Instituto Mexicano del Seguro Social, Centro M&eacute;dico Nacional &ldquo;Adolfo Ruiz Cortines&rdquo;, Hospital de Especialidades No. 14, Servicio de Cirug&iacute;a de Trasplantes. Veracruz, Veracruz</p>

    Jefe de la División en investigación en salud

    Cirugía de Transplante

  • Ernesto Soto-Miranda, <p>Instituto Mexicano del Seguro Social, Centro M&eacute;dico Nacional &ldquo;Adolfo Ruiz Cortines&rdquo;, Hospital de Especialidades No. 14, Servicio de Cirug&iacute;a de Trasplantes. Veracruz, Veracruz</p>

    Medico de Base Nefrologia.

    Servicio de Trasplante Renal.

  • Pedro Iván Moreno-Ley, <p>Instituto Mexicano del Seguro Social, Centro M&eacute;dico Nacional &ldquo;Adolfo Ruiz Cortines&rdquo;, Hospital de Especialidades No. 14, Servicio de Cirug&iacute;a de Trasplantes. Veracruz, Veracruz</p>

    Medico de base cirugia de Trasplantes.

    Servicio de Trasplante Renal.

  • Marco Tulio Méndez-López, <p>Instituto Mexicano del Seguro Social, Centro M&eacute;dico Nacional &ldquo;Adolfo Ruiz Cortines&rdquo;, Hospital de Especialidades No. 14, Servicio de Cirug&iacute;a de Trasplantes. Veracruz, Veracruz</p>

    Medico de Base Nefrologia.

    Servicio de Trasplante Renal.

  • Luis Filadelfo Budar-Fernández, <p>Instituto Mexicano del Seguro Social, Centro M&eacute;dico Nacional &ldquo;Adolfo Ruiz Cortines&rdquo;, Hospital de Especialidades No. 14, Servicio de Cirug&iacute;a de Trasplantes. Veracruz, Veracruz</p>

    Medico de Base Nefrologia.

    Servicio de Trasplante Renal.

  • Sandro Fabricio Ávila-Pardo, <p>Instituto Mexicano del Seguro Social, Centro M&eacute;dico Nacional &ldquo;Adolfo Ruiz Cortines&rdquo;, Hospital de Especialidades No. 14, Servicio de Cirug&iacute;a de Trasplantes. Veracruz, Veracruz</p>

    Medico de Base Nefrologia.

    Servicio de Trasplante Renal.

  • Edgar Guadalupe Aguilar-Sandoval, <p>Instituto Mexicano del Seguro Social, Centro M&eacute;dico Nacional &ldquo;Adolfo Ruiz Cortines&rdquo;, Hospital de Especialidades No. 14, Servicio de Cirug&iacute;a de Trasplantes. Veracruz, Veracruz</p>

    Medico de base cirugia de Trasplantes.

    Servicio de Trasplante Renal.

  • Stefan Zilli-Hernández, <p>Instituto Mexicano del Seguro Social, Centro M&eacute;dico Nacional &ldquo;Adolfo Ruiz Cortines&rdquo;, Hospital de Especialidades No. 14, Servicio de Cirug&iacute;a de Trasplantes. Veracruz, Veracruz</p>

    Servicio de Investigación en salud.

  • Francisco Lajud-Barquín, <p>Instituto Mexicano del Seguro Social, Centro M&eacute;dico Nacional &ldquo;Adolfo Ruiz Cortines&rdquo;, Hospital de Especialidades No. 14, Servicio de Cirug&iacute;a de Trasplantes. Veracruz, Veracruz</p>

    Servicio de Investigación en salud.

  • Lucia Vega-Rojano, <p>Instituto Mexicano del Seguro Social, Centro M&eacute;dico Nacional &ldquo;Adolfo Ruiz Cortines&rdquo;, Hospital de Especialidades No. 14, Servicio de Cirug&iacute;a de Trasplantes. Veracruz, Veracruz</p>

    Servicio de Investigación en salud.

  • Geovanna Coello-Torres, <p>Instituto Mexicano del Seguro Social, Centro M&eacute;dico Nacional &ldquo;Adolfo Ruiz Cortines&rdquo;, Hospital de Especialidades No. 14, Servicio de Cirug&iacute;a de Trasplantes. Veracruz, Veracruz</p>

    Servicio de Investigación en salud.

References

Organ Procurement and Transplantation Network [Internet]. A Guide to Calculating and Interpreting the Estimated Post-Transplant Survival (EPTS) Score Used in the Kidney Allocation System (KAS). Richmond, Virginia: OPTN; actualizado el 17 de mayo de 2019. Disponible en https://optn.transplant.hrsa.gov/media/1511/guide_to_calculating_interpreting_epts.pdf

 

Freitas MC. Kidney transplantation in the US: an analysis of the OPTN/UNOS registry. Clin Transpl. 2011:1-16.

 

Andre M, Huang E, Everly M, Bunnapradist S. The UNOS Renal Transplant Registry: Review of the Last Decade. Clin Transpl. 2014:1-12.

 

Clayton PA, McDonald SP, Snyder JJ, Salkowski N, Chadban SJ. External validation of the estimated posttransplant survival score for allocation of deceased donor kidneys in the United States. Am J Transplant. 2014;14(8):1922-6. doi: 10.1111/ajt.12761.

 

Organ Procurement and Transplantation Network [Internet]. EPTS calculator. Richmond, Virginia: OPTS; guías de cálculo actualizadas el 17 de mayo de 2019. Disponible en https://optn.transplant.hrsa.gov/resources/allocation-calculators/epts-calculator/

 

Ramanathan R, Gupta G, Kim J, Quinn K, Behnke M, Kang L et al. Retroactive Application of the New Kidney Allocation System to Renal Transplants Performed in the ECD/SCD era. Clin Transplant 2015;29:1148-55.

 

Wang CJ, Wetmore JB, Israni AK. Old versus new: Progress in reaching the goals of the new kidney allocation system. Hum Immunol. 2017;78(1):9-15. doi: 10.1016/j.humimm.2016.08.007

 

Stewart DE, Klassen DK. Early Experience with the New Kidney Allocation System: A Perspective from UNOS. Clin J Am Soc Nephrol. 2017;12:2063-5.

 

Chopra B, Sureshkumar KK. Changing Organ Allocation Policy for Kidney Transplantation in the United States. World J Transplant. 2015;5(2):38-43.

 

Schold JD, Buccini LD, Reese PP, Poggio ED, Goldfarb DA. Effect of Dialysis Initiation for Preemptively Listed Candidates in the Revised Kidney Allocation Policy. Am J Transplant. 2014;14(12):2855-60.

 

Andreoni KA, Thomas EM, Battula B, Zarrinpar A, Johnson MW. Is the Updated Kidney Allocation System Working? Curr Transpl Rep. 2018;5(2):166-73.

 

Moss M, Gillespie M, Sparkes T, Ravichandran B, Ugarte R, Haririan A. Kidney Allocation Tool of the Future: The Estimated Post-Transplant Survival (EPTS) Score. 2015 American Transplant Congress. Abstract number: A140. Disponible en https://atcmeetingabstracts.com/abstract/kidney-allocation-tool-of-the-future-the-estimated-post-transplant-survival-epts-score/

 

Stewart D, Kucheryavaya A, Boyle G, Aeder M, Formica R. Should Only Active Candidates Define the EPTS Top 20% in the New Kidney Allocation System (KAS). 2015 American Transplant Congress. Abstract number: 89. Disponible en https://atcmeetingabstracts.com/abstract/should-only-active-candidates-define-the-epts-top-20-in-the-new-kidney-allocation-system-kas/

 

Schold J, Poggio E, Fatica R, Flechner S, Buccini L, Goldfarb D. The Simplified EPTS Score: Who Wins and Who Loses? 2016 American Transplant Congress. Abstract number: C85. Disponible en https://atcmeetingabstracts.com/abstract/the-simplified-epts-score-who-wins-and-who-loses/

 

Liu A, Balabhadrapatruni K, Augustine J. Watch Out for the Guy the Low EPTS Score: Nonadherence and Kidney Allograft Failure. 2016 American Transplant Congress. Abstract number: A283. Disponible en https://atcmeetingabstracts.com/abstract/watch-out-for-the-guy-with-the-low-epts-score-nonadherence-and-kidney-allograft-failure/

 

Staeck O, Khadzhynov D, Kleinsteuber A, Lehner L, Duerr M, Budde K, et al. Evaluation of Scoring Systems Predicting Patient Survival at Time of Kidney Transplantation. 2016 American Transplant Congress. Abstract number: 43. Disponible en https://atcmeetingabstracts.com/abstract/evaluation-of-scoring-systems-predicting-patient-survival-at-time-of-kidney-transplantation/

 

Cantú-Quintanilla G, Sales-Heredia F, Reyes-López A, Rodríguez-Ortega G, Medeiros-Domingo M. En Hospitales en México: criterios de asignación de riñón de pacientes fallecidos. Persona y Bioética, 2009;13(1):20-33. Disponible en http://www.scielo.org.co/scielo.php?script=sci_arttext&pid=S0123-31222009000100003

 

Calisa V, Craig JC, Howard K, Howell M, Alexander S, Chadban SJ et al. Survival and quality of life impact of a risk-based allocation algorithm for deceased donor kidney transplantation. Transplantation. 2018;102(9):1530-7. doi: 10.1097/TP.0000000000002144.

 

Li B, Cairns J, Robb ML, RJ Johnson, Watson CJ, Forsythe JL, et al. Predicting patient survival after deceased donor kidney transplantation using flexible parametric modelling. BMC Nephrol. 2016 May 25;17(1):51. doi: 10.1186/s12882-016-0264-0.

 

Veroux M, Corona D, Veroux P. Kidney transplantation: future challenges. Minerva Chir. 2009;64(1):75-100.

 

Kang SS, Park HY, Yeo SM, Park WY, Han S, Park SB, et al. Comparison of Clinical Outcomes of Deceased Donor Kidney Transplantation according to Donor Evaluation Criteria. Transplantation. 2017;101:S127.

 

García del Moral Martín RM, Retamero-Díaz JA, Cava-Molina M, Cobacho-Tornel BM, Bravo-Soto J, Osuna-Ortega A et al. Validación del KDRI/KPDI para la selección de donantes renales con criterios expandidos. Nefrologia 2018;38(3):297-303. doi: 10.1016/j.nefro.2017.08.006

 

Knoll G. Trends in kidney transplantation over the past decade. Drugs. 2008;68 Suppl 1:3-10.

 

Pascual J, Pérez-Sáez MJ. Kidney Donor Profile Index: Can it be extrapolated to our environment? Nefrologia. 2016;36:465-8.

 

Israni AK, Salkowski N, Gustafson S, Snyder JJ, Friedewald JJ, Formica RN, et al. New national allocation policy for deceased donor kidneys in the United States and possible effect on patient outcomes. J Am Soc Nephrol. 2014;25(8):1842-8. doi: 10.1681/Asn.2013070784

Published

2020-01-30

Issue

Section

Original Articles