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Continuous allocation: The problem with EPTS and pediatric kidney candidates.
Rachel M Engen1, Samantha Weiss2, Caitlin G Peterson3
1Department of Pediatrics, University of Wisconsin Madison, Madison, Wisconsin, USA.
Pediatric Transplantation
|September 12, 2023
Summary
The Estimated Post-Transplant Survival (EPTS) score, used in adult kidney transplants, was evaluated for pediatric patients. The study found that EPTS is not a valid predictor of patient survival in children receiving kidney transplants.
Area of Science:
- Nephrology
- Transplantation
- Pediatric Medicine
Background:
- The 2014 Kidney Allocation System (KAS) uses the Estimated Post-Transplant Survival (EPTS) score for adult kidney transplant candidates.
- EPTS considers age, dialysis duration, diabetes, and prior transplants to predict graft longevity.
- The applicability of EPTS to pediatric kidney transplant recipients is unknown.
Purpose of the Study:
- To evaluate the validity of the EPTS score in predicting patient survival among pediatric kidney transplant recipients.
- To assess whether the EPTS score, designed for adults, performs accurately in a pediatric population.
Main Methods:
- Retrospective cohort study of 6800 pediatric kidney transplant recipients (2001-2011).
- Data sourced from the Organ Procurement and Transplantation Network (OPTN).
- Calculated EPTS scores and compared them to actual patient survival outcomes.
Main Results:
- Median patient age was 14.01 years; median dialysis vintage was 0.67 years.
- The median EPTS score was 2; 7% of patients died during the study.
- The c-statistic for EPTS predictive accuracy was 0.505, indicating poor performance.
Conclusions:
- The Estimated Post-Transplant Survival (EPTS) score is not a valid predictor of patient survival in pediatric kidney transplant recipients.
- Current EPTS scoring system requires re-evaluation for use in pediatric populations.
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