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

Background: Clinical tools to structure kidney transplant waitlist management at the time of listing are limited. We evaluated a simple, donor-independent clinical grading applied at waitlist registration to stratify patients according to post-transplant risk. Methods: We retrospectively analyzed 465 adult kidney transplant recipients from two German centers (2018-2023). Patients were assigned to three clinical grading groups based on age and comorbidities, and to three immunologic groups based on pre-immunization. One-year outcomes included mortality, graft loss, eGFR, albuminuria, and rejection. Results: Higher clinical grades were associated with worse one-year outcomes, including lower eGFR and higher rates of death or graft loss, whereas immunologic grading was associated with waiting time but not short-term post-transplant outcomes. These associations appeared robust to donor characteristics in sensitivity analyses. Conclusions: A simple, listing-time clinical grading may support structured waitlist management before donor information is available. External validation is required.