儿童肾移植受者移植前生存风险评估工具的国际验证。

IF 3.9 2区 医学 Q1 UROLOGY & NEPHROLOGY
Clinical Kidney Journal Pub Date : 2025-01-28 eCollection Date: 2025-03-01 DOI:10.1093/ckj/sfaf031
Loes Oomen, Liesbeth L de Wall, Burkhard Tönshoff, Kai Krupka, Jerome Harambat, Julien Hogan, Cécile Couchoud, Emilie Savoye, Huib de Jong, Elisabeth A M Cornelissen, Antonia H M Bouts, Mandy G Keijzer-Veen, Wout F J Feitz, Charlotte M H H T Bootsma-Robroeks
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引用次数: 0

摘要

背景:使用常用因素的移植前预测模型对于优化儿童肾移植(PKT)受者的供体选择、沟通和咨询是有价值的。本研究旨在外部验证荷兰PKT预测模型,并评估其国际适用性。材料和方法:数据来自Dutch-, CERTAIN-和CRISTAL登记处,涵盖2005年至2021年的PKT。荷兰的预测模型在德国和法国的队列中进行了外部验证,然后对这些特定国家进行了调整。还利用所有现有数据开发了一个国际预测模型。模型基于80%的衍生队列,并使用受试者工作特征曲线(ROC-AUC)下的区域和校准图进行内部验证。结果:3266例移植中,2475例(荷兰273例,德国356例,法国1622例,其他国家224例)用于分析。队列在基线特征和结果上存在显著差异。荷兰模型的内部验证显示,10年和15年的ROC-AUC分别为0.77和0.75。在德国和法国队列的外部验证中,10年ROC-AUC分别为0.63和0.60。国际预测模型的内部验证显示,10年和15年的AUC分别为0.61和0.60,标度较差,表明预测效果较差。调整后的国家模型显示出更好的内部验证性能,荷兰、法国和德国队列的10年ROC-AUC分别为0.77、0.76和0.73。结论:考虑到整个欧洲临床实践的多样性,荷兰PKT预测工具需要在其他国家进行具体的调整。在当前形势下,国别模式比国际模式更可取。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
International validation of a pre-transplant risk assessment tool for graft survival in pediatric kidney transplant recipients.

Background: A pre-transplant prediction model using commonly available factors is valuable for optimizing donor selection, communication, and counseling for pediatric kidney transplant (PKT) recipients. This study aims to externally validate a Dutch PKT prediction model and assess its international applicability.

Materials and methods: Data from the Dutch-, CERTAIN-, and CRISTAL registries, covering PKT from 2005 to 2021, were used. The Dutch prediction model was externally validated in a German and French cohort and then adapted to these specific countries. An international prediction model was also developed using all available data. Models were based on 80% derivation cohorts and internally validated using areas under the receiver operating characteristic curve (ROC-AUC) and calibration plots.

Results: Of 3266 transplantations, 2475 (273 Dutch, 356 German, 1622 French, and 224 other) were used for analysis. Cohorts differed significantly in baseline characteristics and outcomes. Internal validation of the Dutch model showed ROC-AUC of 0.77 and 0.75 at 10 and 15 years. External validation in German and French cohorts yielded 10-year ROC-AUC of 0.63 and 0.60, respectively.Internal validation of the international prediction model showed AUC of 0.61 and 0.60 at 10 and 15 years with poor calibration, indicating inferior performance. The adapted national models showed better internal validation performance, with 10-year ROC-AUC of 0.77, 0.76, and 0.73 in Dutch, French, and German cohorts, respectively.

Conclusions: The Dutch PKT prediction tool requires country-specific adaptations for use in other countries, given the diversity of clinical practice across Europe. A country-specific model is preferable to an international model in the current landscape.

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来源期刊
Clinical Kidney Journal
Clinical Kidney Journal Medicine-Transplantation
CiteScore
6.70
自引率
10.90%
发文量
242
审稿时长
8 weeks
期刊介绍: About the Journal Clinical Kidney Journal: Clinical and Translational Nephrology (ckj), an official journal of the ERA-EDTA (European Renal Association-European Dialysis and Transplant Association), is a fully open access, online only journal publishing bimonthly. The journal is an essential educational and training resource integrating clinical, translational and educational research into clinical practice. ckj aims to contribute to a translational research culture among nephrologists and kidney pathologists that helps close the gap between basic researchers and practicing clinicians and promote sorely needed innovation in the Nephrology field. All research articles in this journal have undergone peer review.
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