Abstract: SA-PO056
Systematic Review of Risk Indices Used in Pancreas Transplantation
Session Information
- Transplantation: Clinical Outcomes
October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 1802 Transplantation: Clinical
Authors
- Ling, Jonathan E.H., Monash Medical Centre and Monash University, Melbourne, Victoria, Australia
- Coughlan, Timothy Edward, Monash Health, Hawthorn, New South Wales, Australia
- Polkinghorne, Kevan, Monash Medical Centre and Monash University, Melbourne, Victoria, Australia
- Kanellis, John, Monash Medical Centre, Clayton, Victoria, Australia
Background
Risk indices (RI) using donor and recipient characteristics assist in organ allocation and acceptance decisions by predicting post-transplant outcomes such as graft and patient survival. While RI have been derived for use in pancreas transplantation (PTx), they are not widely utilised. We intend to review the ability of available RI to predict PTx outcomes.
Methods
Medline Plus, Embase via OVID and the Cochrane Library were searched for studies describing derivation or use of RI in PTx up to 1st November 2017. Primary outcomes of interest were pancreas graft and patient survival, with secondary outcomes of organ acceptance. Data extraction was performed using the Checklist for Critical Appraisal and data extraction for Systematic Reviews of Prediction Modelling Studies (CHARMS) and risk of bias assessment was done via the Quality in Prognostic Studies (QUIPS) tool.
Results
2418 abstracts were screened with 32 studies entering full-text analysis. Of these 32 studies, 8 were abstracts with no full-text retrievable despite contacting authors. 10/32 studies derived 23 models predicting outcomes of interest. 2/23 models were RI that were externally validated in 24/32 studies. 21/23 models were derived without external validation. RI were the pancreas donor risk index (PDRI) and the pancreas pre-procurement score (P-PASS). Apart from their covariates, common covariates in other models included recipient age and body mass index (BMI), dialysis duration pre-transplant, history of diabetes, transplant type, and immunosuppression regimen. Risk of bias was generally low in the studies with model derivation. Conversely, abstracts tended to have high risk of bias. Deficiencies in reporting included handling of missing data, covariates and follow-up duration. Discrimination and calibration was only described in 10 and 2 studies respectively. Heterogeneity was present in model derivation method, outcome definitions and study results. PDRI was significantly associated with pancreas graft survival in 9 studies and P-PASS was significantly associated with pancreas donor acceptance in 3 studies.
Conclusion
RI in PTx have not been widely validated apart from P-PASS and PDRI. Within a validated cohort, PDRI (as a categorical variable) and P-PASS have value in predicting pancreas graft survival and in predicting donor pancreas acceptance respectively.