A Novel Pre-Kidney Transplant Risk Score to Optimize Waiting List Management.

Area of Science:

• Nephrology
• Transplant Surgery
• Clinical Epidemiology

Background:

• Limited clinical tools exist for structuring kidney transplant waitlist management at the time of patient listing.
• A need exists to stratify patients based on post-transplant risk using donor-independent factors early in the waitlist process.

Purpose of the Study:

• To evaluate a simple, donor-independent clinical grading system applied at waitlist registration for stratifying kidney transplant recipients according to post-transplant risk.
• To assess the association between clinical and immunologic grading at listing and one-year post-transplant outcomes.

Main Methods:

• Retrospective analysis of 465 adult kidney transplant recipients from two German centers (2018-2023).
• Patients were stratified into three clinical grading groups (based on age and comorbidities) and three immunologic groups (based on pre-immunization).
• One-year outcomes analyzed included mortality, graft loss, estimated glomerular filtration rate (eGFR), albuminuria, and rejection.

Main Results:

• Higher clinical grades at listing were significantly associated with worse one-year outcomes, including lower eGFR and increased rates of death or graft loss.
• Immunologic grading correlated with waiting time but did not show a significant association with short-term post-transplant outcomes.
• The observed associations between clinical grade and outcomes remained robust even after considering donor characteristics.

Conclusions:

• A straightforward clinical grading system implemented at the time of kidney transplant listing can effectively support structured waitlist management.
• This clinical grading provides valuable prognostic information prior to donor availability, aiding in patient stratification.
• External validation of this clinical grading tool is recommended to confirm its generalizability and utility in broader clinical practice.