*Purpose: Risk scores may aid risk quantification and decision-making in kidney transplantation. The Living Kidney Donor Profile Index (LKDPI) was developed to choose between living donors. The original LKDPI is moderately discriminatory (Harrel’s C Statistic=0.59,95% CI 0.55-0.61) but poorly calibrated in Australia/New Zealand. We developed a risk prediction score for overall graft survival in adult recipients of a living kidney donor transplant in an Australian and New Zealand population.

*Methods: Using data from the Australia and New Zealand Dialysis and Transplant Registry, we included adult recipients of living kidney donor transplants over 2004-2018. We constructed Cox models for overall graft survival. We refit the original USA variables and then constructed a new model (ANZ LKDPI) considering all available potential covariates. Model performance was validated by assessing discrimination and calibration.

*Results: 4049 living donors were included. The C-statistic for the re-fit model was 0.57(95%CI 0.54-0.59). The remodeled score included the new variables history of hypertension and HLA-A mismatches. Variables excluded were donor:recipient weight ratio, HLA-B, both male, and ABO incompatibility. The ANZ LKDPI had similar discrimination (C=0.56,95%CI 0.54-0.58). The model fit and calibration was better.

*Conclusions: The ANZ LKDPI had similar discrimination to the original and the refitted LKDPI. The discrimination was low for both scores and so should be used with caution to decide between donors. The new score is better calibrated for our population so could be used to predict individual graft prognosis.

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