Irish et al developed a nomogram for predicting the probability of delayed graft function following adult cadaveric renal transplantation. This can help identify a patient who may benefit from interventions to reduce the risk of delayed graft function and from closer monitoring. The authors are from 5 transplant centers from across the United States (Durham, Cincinnati, Fremont, Palo Alto and St Louis).
Delayed graft function is the need for dialysis during the first week after transplantation.
Parameters - donor:
(1) donor's age
(2) donor's serum creatinine
(3) donor's heart beating
(4) donor's history of hypertension
(5) donor's cause of death
Parameters - transplanted kidney:
(6) number of HLA mismatches
(7) duration of cold ischemia in hours
Parameters - recipient:
(8) peak panel-reactive antibody in percent (from 0 to 100)
(9) race and pretransplantation dialysis of recipient
(10) number of organs transplanted and pretransplantation dialysis of recipient
(11) history of previous transplant in recipient
(12) recipient's gender
(13) recipient's history of diabetes
(14) recipient required transfusion prior to transplant
|
Parameter |
Finding |
Points |
|---|---|---|
|
donor's age in years |
13 |
0 |
|
|
23 |
4.4 |
|
|
33 |
8.8 |
|
|
43 |
13.1 |
|
|
53 |
17.5 |
|
|
63 |
21.9 |
|
|
73 |
26.3 |
|
|
83 |
30.6 |
|
|
93 |
35 |
|
donor's serum creatinine |
0 |
0 |
|
|
1 |
5.2 |
|
|
2 |
10.3 |
|
|
3 |
15.5 |
|
|
4 |
20.6 |
|
donor's heart beating |
yes |
0 |
|
|
no |
29 |
|
donor's history of hypertension |
no hypertension |
0 |
|
|
hypertension |
7 |
|
donor's cause of death |
anoxia |
5 |
|
|
cerebrovascular stroke |
4 |
|
|
other |
0 |
|
number of HLA mismatches |
0 |
0 |
|
|
1 |
1.7 |
|
|
2 |
3.6 |
|
|
3 |
5.5 |
|
|
4 |
7.4 |
|
|
5 |
9.3 |
|
|
6 |
11.3 |
|
duration of cold ischemia |
number of hours |
|
|
peak PRA in percent |
0% |
0 |
|
|
20% |
3.4 |
|
|
40% |
6.8 |
|
|
60% |
10.2 |
|
|
80% |
13.6 |
|
|
100% |
17.0 |
|
race and pretransplant dialysis |
black and no dialysis |
44 |
|
|
black and dialysis |
46 |
|
|
not black and no dialysis |
18 |
|
|
not black and dialysis |
38 |
|
number of renal transplants and pretransplant dialysis |
single transplant and pretransplant dialysis |
40 |
|
|
multiple organ transplant and pretransplant dialysis |
20 |
|
|
no pretransplant dialysis |
0 |
|
recipient's transplant history |
no previous transplant |
0 |
|
|
previous transplant |
10 |
|
gender of recipient |
female |
0 |
|
|
male |
7 |
|
diabetes in recipient |
absent |
0 |
|
|
present |
5 |
|
recipient transfusion pretransplant |
none |
0 |
|
|
present |
4 |
points for donor's age between 13 and 93 =
= (0.4373 * (age in years)) - 5.668
points for donor's serum creatinine =
= (5.15 * (creatinine in mg/dL)) + 0.02
points for panel-reactive antibody =
= 0.17 * (peak PRA in percent)
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score: 220 or more
• The higher the score the more likely that delayed function will occur.
|
Total Score |
Probability Delayed Function |
|---|---|
|
0 - 89 |
< 10% |
|
90 - 145.9 |
(0.0066039 * ((points)^2)) - (0.835639 * (points)) + 31.612771 |
|
146 - 201 |
(-0.00582 * ((points)^2)) + (2.75581 * (points)) - 228.6314 |
|
> 201 |
> 90% |
Specialty: Nephrology, Clinical Laboratory, Surgery, general
