Conceptualization, C.T., Y.R., C.C.J., S.A.M., M.A.M., P.V., P.C.A., N.L., W.K., P.P., S.T., P.K., P.N., M.C. and W.C.; Data curation, C.T. and N.L.; Formal analysis, C.T. and W.C.; Funding acquisition, W.C.; Investigation, C.T., Y.R., P.V., W.K. and W.C.; Methodology, C.T., Y.R., S.A.M., P.P., S.T., P.K., P.N., M.C. and W.C.; Project administration, S.A.M., M.A.M., P.C.A., N.L., S.T., P.N., M.C. and W.C.; Resources, W.C.; Software, W.C.; Supervision, C.T., C.C.J., S.A.M., M.A.M., P.P., M.C. and W.C.; Validation, C.T., Y.R., C.C.J., W.K., P.K. and W.C.; Visualization, C.T., Y.R., P.P. and W.C.; Writing—original draft, C.T., Y.R. and W.C.; Writing—review and editing, C.T., Y.R., C.C.J., S.A.M., M.A.M., P.V., P.C.A., N.L., W.K., P.P., S.T., P.K., P.N., M.C. and W.C. All authors have read and agreed to the published version of the manuscript.
Figure 1. (A). CDF plot displaying consensus distributions for each k; (B). Delta area plot reflecting the relative changes in the area under the CDF curve. (C). Consensus matrix heat map depicting consensus values on a white to blue color scale of each cluster.
Figure 1. (A). CDF plot displaying consensus distributions for each k; (B). Delta area plot reflecting the relative changes in the area under the CDF curve. (C). Consensus matrix heat map depicting consensus values on a white to blue color scale of each cluster.
Figure 2. The bar plot represents the mean consensus score for different numbers of clusters (from two to ten). Different colors indicate different cluster groups.
Figure 2. The bar plot represents the mean consensus score for different numbers of clusters (from two to ten). Different colors indicate different cluster groups.
Figure 3. (A). The standardized differences across cluster 1 for each of baseline parameters. The x axis is the standardized differences value, and the y axis shows baseline parameters. The dashed vertical lines represent the standardized differences cutoffs of <−0.3 or >0.3. Abbreviations: BMI: Body mass index, CMV: Cytomegalovirus, D: Donor, DGF: Delayed graft function, DM: diabetes mellitus, EBV: Epstein–Barr virus, ECD: Extended criteria donor, ESKD: end stage kidney disease, GN: Glomerulonephritis, HBs: Hepatitis B surface, HCV: Hepatitis C virus, HIV: Human immunodeficiency virus, HLA: Human leucocyte antigen, HTN: Hypertension, KDPI: Kidney donor profile index, mTOR: Mammalian target of rapamycin, PKD: Polycystic kidney disease, PRA: Panel reactive antibody, PVD: peripheral vascular disease, R: Recipient. (B). The standardized differences across cluster 2 for each of baseline parameters. The x axis is the standardized differences value, and the y axis shows baseline parameters. The dashed vertical lines represent the standardized differences cutoffs of <−0.3 or >0.3. Abbreviations: BMI: Body mass index, CMV: Cytomegalovirus, D: Donor, DGF: Delayed graft function, DM: diabetes mellitus, EBV: Epstein–Barr virus, ECD: Extended criteria donor, ESKD: end stage kidney disease, GN: Glomerulonephritis, HBs: Hepatitis B surface, HCV: Hepatitis C virus, HIV: Human immunodeficiency virus, HLA: Human leucocyte antigen, HTN: Hypertension, KDPI: Kidney donor profile index, mTOR: Mammalian target of rapamycin, PKD: Polycystic kidney disease, PRA: Panel reactive antibody, PVD: peripheral vascular disease, R: Recipient. (C). The standardized differences across cluster 3 for each of baseline parameters. The x axis is the standardized differences value, and the y axis shows baseline parameters. The dashed vertical lines represent the standardized differences cutoffs of <−0.3 or >0.3. Abbreviations: BMI: Body mass index, CMV: Cytomegalovirus, D: Donor, DGF: Delayed graft function, DM: diabetes mellitus, EBV: Epstein–Barr virus, ECD: Extended criteria donor, ESKD: end stage kidney disease, GN: Glomerulonephritis, HBs: Hepatitis B surface, HCV: Hepatitis C virus, HIV: Human immunodeficiency virus, HLA: Human leucocyte antigen, HTN: Hypertension, KDPI: Kidney donor profile index, mTOR: Mammalian target of rapamycin, PKD: Polycystic kidney disease, PRA: Panel reactive antibody, PVD: peripheral vascular disease, R: Recipient. (D). The standardized differences across cluster 4 for each of baseline parameters. The x axis is the standardized differences value, and the y axis shows baseline parameters. The dashed vertical lines represent the standardized differences cutoffs of <−0.3 or >0.3. Abbreviations: BMI: Body mass index, CMV: Cytomegalovirus, D: Donor, DGF: Delayed graft function, DM: diabetes mellitus, EBV: Epstein–Barr virus, ECD: Extended criteria donor, ESKD: end stage kidney disease, GN: Glomerulonephritis, HBs: Hepatitis B surface, HCV: Hepatitis C virus, HIV: Human immunodeficiency virus, HLA: Human leucocyte antigen, HTN: Hypertension, KDPI: Kidney donor profile index, mTOR: Mammalian target of rapamycin, PKD: Polycystic kidney disease, PRA: Panel reactive antibody, PVD: peripheral vascular disease, R: Recipient. (E). The standardized differences across cluster 5 for each of baseline parameters. The x axis is the standardized differences value, and the y axis shows baseline parameters. The dashed vertical lines represent the standardized differences cutoffs of <−0.3 or >0.3. Abbreviations: BMI: Body mass index, CMV: Cytomegalovirus, D: Donor, DGF: Delayed graft function, DM: diabetes mellitus, EBV: Epstein–Barr virus, ECD: Extended criteria donor, ESKD: end stage kidney disease, GN: Glomerulonephritis, HBs: Hepatitis B surface, HCV: Hepatitis C virus, HIV: Human immunodeficiency virus, HLA: Human leucocyte antigen, HTN: Hypertension, KDPI: Kidney donor profile index, mTOR: Mammalian target of rapamycin, PKD: Polycystic kidney disease, PRA: Panel reactive antibody, PVD: peripheral vascular disease, R: Recipient. (F). The standardized differences across cluster 6 for each of baseline parameters. The x axis is the standardized differences value, and the y axis shows baseline parameters. The dashed vertical lines represent the standardized differences cutoffs of <−0.3 or >0.3. Abbreviations: BMI: Body mass index, CMV: Cytomegalovirus, D: Donor, DGF: Delayed graft function, DM: diabetes mellitus, EBV: Epstein–Barr virus, ECD: Extended criteria donor, ESKD: end stage kidney disease, GN: Glomerulonephritis, HBs: Hepatitis B surface, HCV: Hepatitis C virus, HIV: Human immunodeficiency virus, HLA: Human leucocyte antigen, HTN: Hypertension, KDPI: Kidney donor profile index, mTOR: Mammalian target of rapamycin, PKD: Polycystic kidney disease, PRA: Panel reactive antibody, PVD: peripheral vascular disease, R: Recipient.
Figure 3. (A). The standardized differences across cluster 1 for each of baseline parameters. The x axis is the standardized differences value, and the y axis shows baseline parameters. The dashed vertical lines represent the standardized differences cutoffs of <−0.3 or >0.3. Abbreviations: BMI: Body mass index, CMV: Cytomegalovirus, D: Donor, DGF: Delayed graft function, DM: diabetes mellitus, EBV: Epstein–Barr virus, ECD: Extended criteria donor, ESKD: end stage kidney disease, GN: Glomerulonephritis, HBs: Hepatitis B surface, HCV: Hepatitis C virus, HIV: Human immunodeficiency virus, HLA: Human leucocyte antigen, HTN: Hypertension, KDPI: Kidney donor profile index, mTOR: Mammalian target of rapamycin, PKD: Polycystic kidney disease, PRA: Panel reactive antibody, PVD: peripheral vascular disease, R: Recipient. (B). The standardized differences across cluster 2 for each of baseline parameters. The x axis is the standardized differences value, and the y axis shows baseline parameters. The dashed vertical lines represent the standardized differences cutoffs of <−0.3 or >0.3. Abbreviations: BMI: Body mass index, CMV: Cytomegalovirus, D: Donor, DGF: Delayed graft function, DM: diabetes mellitus, EBV: Epstein–Barr virus, ECD: Extended criteria donor, ESKD: end stage kidney disease, GN: Glomerulonephritis, HBs: Hepatitis B surface, HCV: Hepatitis C virus, HIV: Human immunodeficiency virus, HLA: Human leucocyte antigen, HTN: Hypertension, KDPI: Kidney donor profile index, mTOR: Mammalian target of rapamycin, PKD: Polycystic kidney disease, PRA: Panel reactive antibody, PVD: peripheral vascular disease, R: Recipient. (C). The standardized differences across cluster 3 for each of baseline parameters. The x axis is the standardized differences value, and the y axis shows baseline parameters. The dashed vertical lines represent the standardized differences cutoffs of <−0.3 or >0.3. Abbreviations: BMI: Body mass index, CMV: Cytomegalovirus, D: Donor, DGF: Delayed graft function, DM: diabetes mellitus, EBV: Epstein–Barr virus, ECD: Extended criteria donor, ESKD: end stage kidney disease, GN: Glomerulonephritis, HBs: Hepatitis B surface, HCV: Hepatitis C virus, HIV: Human immunodeficiency virus, HLA: Human leucocyte antigen, HTN: Hypertension, KDPI: Kidney donor profile index, mTOR: Mammalian target of rapamycin, PKD: Polycystic kidney disease, PRA: Panel reactive antibody, PVD: peripheral vascular disease, R: Recipient. (D). The standardized differences across cluster 4 for each of baseline parameters. The x axis is the standardized differences value, and the y axis shows baseline parameters. The dashed vertical lines represent the standardized differences cutoffs of <−0.3 or >0.3. Abbreviations: BMI: Body mass index, CMV: Cytomegalovirus, D: Donor, DGF: Delayed graft function, DM: diabetes mellitus, EBV: Epstein–Barr virus, ECD: Extended criteria donor, ESKD: end stage kidney disease, GN: Glomerulonephritis, HBs: Hepatitis B surface, HCV: Hepatitis C virus, HIV: Human immunodeficiency virus, HLA: Human leucocyte antigen, HTN: Hypertension, KDPI: Kidney donor profile index, mTOR: Mammalian target of rapamycin, PKD: Polycystic kidney disease, PRA: Panel reactive antibody, PVD: peripheral vascular disease, R: Recipient. (E). The standardized differences across cluster 5 for each of baseline parameters. The x axis is the standardized differences value, and the y axis shows baseline parameters. The dashed vertical lines represent the standardized differences cutoffs of <−0.3 or >0.3. Abbreviations: BMI: Body mass index, CMV: Cytomegalovirus, D: Donor, DGF: Delayed graft function, DM: diabetes mellitus, EBV: Epstein–Barr virus, ECD: Extended criteria donor, ESKD: end stage kidney disease, GN: Glomerulonephritis, HBs: Hepatitis B surface, HCV: Hepatitis C virus, HIV: Human immunodeficiency virus, HLA: Human leucocyte antigen, HTN: Hypertension, KDPI: Kidney donor profile index, mTOR: Mammalian target of rapamycin, PKD: Polycystic kidney disease, PRA: Panel reactive antibody, PVD: peripheral vascular disease, R: Recipient. (F). The standardized differences across cluster 6 for each of baseline parameters. The x axis is the standardized differences value, and the y axis shows baseline parameters. The dashed vertical lines represent the standardized differences cutoffs of <−0.3 or >0.3. Abbreviations: BMI: Body mass index, CMV: Cytomegalovirus, D: Donor, DGF: Delayed graft function, DM: diabetes mellitus, EBV: Epstein–Barr virus, ECD: Extended criteria donor, ESKD: end stage kidney disease, GN: Glomerulonephritis, HBs: Hepatitis B surface, HCV: Hepatitis C virus, HIV: Human immunodeficiency virus, HLA: Human leucocyte antigen, HTN: Hypertension, KDPI: Kidney donor profile index, mTOR: Mammalian target of rapamycin, PKD: Polycystic kidney disease, PRA: Panel reactive antibody, PVD: peripheral vascular disease, R: Recipient.
Figure 4. Proportion of the assigned clusters based on the UNOS regions.
Figure 4. Proportion of the assigned clusters based on the UNOS regions.
Figure 5. (A). Patient survival after kidney transplant from high KDPI deceased donors in the U.S. (B). Death-censored graft survival after kidney transplant from high KDPI deceased donors in the U.S. (C). Death-censored graft survival after kidney transplant from high KDPI deceased donors in the U.S.
Figure 5. (A). Patient survival after kidney transplant from high KDPI deceased donors in the U.S. (B). Death-censored graft survival after kidney transplant from high KDPI deceased donors in the U.S. (C). Death-censored graft survival after kidney transplant from high KDPI deceased donors in the U.S.
Table 1. Clinical characteristics according to clusters.
Table 1. Clinical characteristics according to clusters.
AllWhite
-Black
-Hispanic
-Other
A
-B
-AB
-O
Preemptive
-<1 year
-1–3 years
->3 years
Diabetes mellitus
-Hypertension
-Glomerular disease
-PKD
-Other
Diabetes mellitus
-Malignancy
-Peripheral vascular disease
10–30%
-40–70%
-80–100%
Non-ECD deceased
-ECD deceased
White
-Black
-Hispanic
-Other
Local
-Regional
-National
Low risk
-Moderate risk
-High risk
D−/R−
-D−/R+
-D+/R+
-D+/R−
Thymoglobulin
-Alemtuzumab
-Basiliximab
-Other
-No induction
Tacrolimus
-Cyclosporine
-Mycophenolate
-Azathioprine
-mTOR inhibitors
-Steroid
Table 2. Post-transplant outcomes according to the clusters.
Table 2. Post-transplant outcomes according to the clusters.
Cluster 1Cluster 2Cluster 3Cluster 4Cluster 5Cluster 6Primary non-function36 (1.8%)26 (1.2%)5 (1.4%)4 (1.2%)7 (0.7%)31 (1.0%)Delayed graft function759 (38.3%)535 (25.1%)149 (41.7%)101 (30.2%)340 (31.8%)1247 (40.8%)1-year survival95.3%93.9%91.0%98.1%92.2%92.5%5-year survival79.2%68.6%62.1%90.5%68.9%67.0%1-year death-censored graft survival91.2%94.3%87.8%85.6%93.4%92.3%5-year death-censored graft survival73.1%84.3%70.1%81.8%80.5%76.2%1-year graft survival88.1%90.2%81.8%84.8%88.6%87.3%5-year graft survival63.9%64.2%53.2%76.9%63.4%58.9%1-year acute rejection157 (7.9%)134 (6.3%)38 (10.6%)8 (2.4%)69 (6.5%)200 (6.6%)
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