Graft failure and recipient death with functioning graft are important competing outcomes after kidney transplantation. Risk prediction models typically censor for the competing outcome thereby overestimating the cumulative incidence. The magnitude of this overestimation is not well described in real-world transplant data. This retrospective cohort study analyzed data from the European Collaborative Transplant Study (n = 125 250) and from the American Scientific Registry of Transplant Recipients (n = 190 258). Separate cause-specific hazard models using donor and recipient age as continuous predictors were developed for graft failure and recipient death. The hazard of graft failure increased quadratically with increasing donor age and decreased decaying with increasing recipient age. The hazard of recipient death increased linearly with increasing donor and recipient age. The cumulative incidence overestimation due to competing risk-censoring was largest in high-risk populations for both outcomes (old donors/recipients), sometimes amounting to 8.4 and 18.8 percentage points for graft failure and recipient death, respectively. In our illustrative model for posttransplant risk prediction, the absolute risk of graft failure and death is overestimated when censoring for the competing event, mainly in older donors and recipients. Prediction models for absolute risks should treat graft failure and death as competing events.

中文翻译：

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使用连续的供体-受体年龄组合来估计肾移植后移植失败和患者死亡风险的竞争风险模型


移植失败和移植物功能正常的受者死亡是肾移植后重要的竞争结果。风险预测模型通常会对竞争结果进行审查，从而高估累积发生率。现实世界的移植数据并没有很好地描述这种高估的程度。这项回顾性队列研究分析了欧洲合作移植研究 (n = 125 250) 和美国移植受者科学登记处 (n = 190 258) 的数据。使用供体和受体年龄作为移植失败和受体死亡的连续预测因子，开发了单独的特定原因危险模型。移植失败的风险随着供体年龄的增加而呈二次方增加，并且随着受者年龄的增加而减少腐烂。受赠者死亡的风险随着供体和受赠者年龄的增加而线性增加。由于竞争性风险审查导致的累积发生率高估在两种结果（老供者/受者）的高风险人群中最大，有时移植失败和受者死亡分别达到 8.4 和 18.8 个百分点。在我们的移植后风险预测说明性模型中，在对竞争事件（主要是老年供体和受者）进行审查时，移植失败和死亡的绝对风险被高估。绝对风险的预测模型应将移植失败和死亡视为竞争事件。