*Purpose: The Scientific Registry of Transplant Recipients (SRTR) utilizes the calculated estimated posttransplant survival (EPTS) score as the measure of post kidney transplant survival to guide allocation of deceased donor kidney transplantation. This score does not include any metric of functional capacity. Peak oxygen uptake (VO_2peak), is an established marker of functional capacity and predictor of survival among both the general and diseased populations.

*Methods: We compared the association, predictive ability and discriminative capacity of VO_2peak measured prior to transplant vs. the EPTS score and all-cause mortality post kidney transplant.

*Results: Among a cohort of 158 transplant recipients (65% deceased donor) with at least 3 years post-transplant follow-up, the median VO_2peak was 14.9 ml/Kg/min. 1 unit increase in the pre-transplant VO_2peak conferred approximately a 20% reduction in mortality (Hazard ratio (HR), adjusted for age, diabetes and coronary heart disease = 0.81, Confidence Interval (CI) = (0.644 – 1.007), p=(0.058) and 10 unit increase in the EPTS score conferred approximately a 5% increase in mortality, albeit not statistically significant (Hazard ratio (HR), adjusted for gender and coronary heart disease = 1.055, Confidence Interval (CI) = (0.825-1.349), p=(0.668). The discriminatory capacity for the model with EPTS was lower than VO_2peak (C-statistic of 0.685 vs. 0.781). We also observed among the cohort of “low risk” patients (defined as patients with EPTS score <50) those with lower VO_2peak had significantly higher risk of mortality. This increased mortality risk in the low-EPTS and low VO_2peak cohort was equivalent to those with high EPTS score cohort.

*Conclusions: VO_2peak demonstrated improved association and discriminatory capacity of patient survival than EPTS score. Thus, in our single center study cohort functional capacity as defined as VO_2peak was an important reflection of post-transplant survival. Among “low risk” patients with EPTS <50, EPTS alone without VO_2peak did not accurately capture true patient survival.

« Back to 2019 American Transplant Congress