Purpose: Optimal glomerular filtration rate (GFR) and timing for living preemptive kidney transplantation (PKT) is not well studied.

Method: We developed an online engine to calculate the optimal GFR level for preemptive transplantation between a given patient-donor pair. The online calculator prompts the user to input 12 characteristics about the patient and donor as well as patient's perceived quality of life in different stages of chronic kidney disease (CKD) and after transplantation. These parameters include donor's age and ethnicity, and patient's age, ethnicity, gender, CKD diagnosis, calculated panel reactive antibody, body mass index ratio and current GFR. Blood relationship status and number of HLA-mismatches between patient and donor are also inquired. Inputs from the user are fed to a Monte-Carlo simulation which generates a transition matrix among GFR ranges using published literature on the annual GFR decline rates. In addition, the user inputs, along with graft survival data and associated risk adjustment coefficients provided by SRTR and post-dialysis life expectancy tables from USRDS Annual Report, are used in a multivariate Cox-proportional hazards model to predict patient's post-transplant life expectancy. The GFR transitions and patient's predicted post-transplant life expectancy were employed by a dynamic decision model.

Results: The tool presents optimal GFR threshold to receive the transplant, expected life span, survival gain due to delayed transplantation, survival gain due to preemptive transplantation, time to transplant for optimal outcomes and risk of death prior to transplantation. The tool is publicly accessible. Below is a snapshot from the inputs section of the tool for a prototype patient-donor profile for whom the calculator presents 15 mL/min/1.73 m² as the optimal GFR threshold for transplantation.

Conclusion: We devised a decision support tool to promote shared decision making between patient-donor pairs and physicians.

CITATION INFORMATION: Barah M., Kurt M., Khojandi A., Tanriover B. Living-Donor Preemptive Kidney Transplant Timing Calculator: An Online Decision Support Tool Am J Transplant. 2017;17 (suppl 3).

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