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Volume 78, Issue 12, Pages (December 2010)

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1 Volume 78, Issue 12, Pages 1288-1294 (December 2010)
A clinical scoring system highly predictive of long-term kidney graft survival  Yohann Foucher, Pascal Daguin, Ahmed Akl, Michèle Kessler, Marc Ladrière, Christophe Legendre, Henri Kreis, Lionel Rostaing, Nassim Kamar, Georges Mourad, Valérie Garrigue, François Bayle, Bruno H. de Ligny, Mathias Büchler, Carole Meier, Jean P. Daurès, Jean-Paul Soulillou, Magali Giral  Kidney International  Volume 78, Issue 12, Pages (December 2010) DOI: /ki Copyright © 2010 International Society of Nephrology Terms and Conditions

2 Figure 1 Evolution of the risk to return in dialysis according to the 10 Kidney Transplant Failure Score (KTFS) categories. The hazard ratios according to the 10 KTFS categories are defined by quantiles. The reference group is the lower KTFS interval with hazard ratio=1 (horizontal line). The vertical lines represent the 95% confidence intervals of each hazard ratio (n=2169; 871 patients excluded from the computation of the KTFS owing to the missing values for certain parameters). Kidney International  , DOI: ( /ki ) Copyright © 2010 International Society of Nephrology Terms and Conditions

3 Figure 2 Distribution of the Kidney Transplant Failure Score (KTFS) calculated in the training population (n=2169). Histogram of the KTFS calculated in the training population, representing the distribution of the composite end point (n=2169). Kidney International  , DOI: ( /ki ) Copyright © 2010 International Society of Nephrology Terms and Conditions

4 Figure 3 8-Year predictive properties of the Kidney Transplant Failure Score (KTFS). (a) Receiver–operator characteristic (ROC) curves for 8-year predictions to evaluate the prognostic capacity of the different markers. The KTFS (black line, AUC=0.78) is the most predictive marker. The usual surrogate markers, 1-year Cr (red line, AUC=0.73) and 1-year estimated graft filtration rate (eGFR; green line, AUC=0.70), show lower predictive capacities. The evolution of creatinine (Cr) between 6 and 12 months is the worst marker (blue lines, AUC=0.60). The area under the ROC curve of the KTFS is higher than those of the others (P<0.0001, one-tailed test by bootstrap resampling). (b) ROC curves for 8-year prediction applied to the independent testing set. The results are similar to those obtained in the training set. The KTFS (black line, AUC=0.78) is the most predictive marker. The usual surrogate markers, 1-year Cr (red line, AUC=0.67) and 1-year eGFR (green line, AUC=0.67), show lower predictive capacities. The evolution of Cr between 6 and 12 months is the worst marker (blue line, AUC=0.61). The area under the ROC curve of the KTFS is higher than those of the others (P<0.05, one-tailed test by bootstrap resampling). Kidney International  , DOI: ( /ki ) Copyright © 2010 International Society of Nephrology Terms and Conditions

5 Figure 4 Graft survival functions according to the Kidney Transplant Failure Score (KTFS) grades (threshold calculated at 4.17 by maximizing both the sensitivity and the specificity). (a) Estimation of transplant survival during the first 8 years post-transplantation and according to the two grades defined at 1-year post-transplantation. The dark line indicates the low-risk subgroup (grade I), with a 93% probability of having a functional kidney at 8 years post-transplantation. The survival of the grade II subgroup (red line) is lower, with an 8-year probability of survival estimated at 70.2%. The difference between the two curves is highly significant (log-rank test, P< ). (b) These are the same survival curves, but estimated from the test set. The dark line represents the low-risk subgroup (grade I), with a 91.8% probability of having a functional kidney at 8 years post-transplantation. The survival of the grade II subgroup (red line) is lower with an 8-year probability of survival estimated at 75.8%. The difference between the two curves is still highly significant (log-rank test, P< ). Kidney International  , DOI: ( /ki ) Copyright © 2010 International Society of Nephrology Terms and Conditions


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