Supplementary Material for: Predicting outcomes after transplantation of deceased donor kidneys of marginal quality within the Eurotransplant service area

Introduction: Kidneys of marginal quality are increasingly being used to overcome the shortage of donor organs. However, accurate prediction of outcome is needed to optimise the use of these kidneys. We aimed to test the performance of a recently proposed score consisting of delayed graft function (DGF), renal function recovery (RFR), and glomerular filtration rate (GFR) <30 ml/min per 1.73 m2 90 days after transplantation for risk assessment of patient and graft survival.

Material and Methods: A total of 221 adult brain death donors with marginal kidneys, transplanted into 223 recipients within Eurotransplant were included in the analysis. Multivariable Cox proportional hazards models were constructed to assess death-censored and all-cause censored graft failure and recipient mortality at one and three years.

Results: Recipients with DGF had a higher risk of death-censored graft loss (HR, 95%CIs: 3.058 (1.195 - 7.825)). Recipients with a GFR <30ml/min/1.73m² at 90 days after transplantation had a higher risk of death censored and all-cause graft failure (HR, 95%CIs: 2.122 (1.129-3.990 and 2.122 (1.129 - 3.990)). None of the three components of the proposed score was associated with a higher risk of mortality.

Conclusion: DGF and eGFR <30 ml/min/1.73m² but not RFR at 90 days predicted graft failure after transplantation of marginal kidneys. However, no combination of these factors was able to predict short-term patient and graft survival.

引言：为缓解供体器官短缺问题，边缘供肾的临床应用日益增多。但需精准预测预后以优化此类供肾的使用效率。本研究旨在验证一项近期提出的评分模型的性能，该模型由移植后90天的移植物功能延迟恢复（delayed graft function, DGF）、肾功能恢复（renal function recovery, RFR）及肾小球滤过率（glomerular filtration rate, GFR）＜30ml/min/1.73m²三项指标构成，用于评估患者与移植物存活风险。
材料与方法：本研究纳入欧洲移植协作组（Eurotransplant）内221例携带边缘供肾的成人脑死亡供体，共完成223例受体肾移植，全部纳入分析。构建多变量Cox比例风险回归模型，分别评估1年及3年时的死亡截尾移植物失功、全因截尾移植物失功以及受体死亡率。
结果：伴DGF的受体发生死亡截尾移植物失功的风险更高（风险比[HR]，95%置信区间[95%CI]：3.058，1.195~7.825）。移植后90天GFR＜30ml/min/1.73m²的受体，其死亡截尾及全因移植物失功风险均更高（HR，95%CI：2.122，1.129~3.990及2.122，1.129~3.990）。该评分模型的三项组成指标均与更高的死亡率风险无显著关联。
结论：移植后90天的DGF及估算肾小球滤过率（eGFR）＜30ml/min/1.73m²可预测边缘供肾移植后的移植物失功，但RFR无此预测价值。然而，上述指标的任意组合均无法预测短期患者与移植物存活情况。