Title: Risk Indices Predicting Graft use, Graft and Patient Survival in Solid Pancreas
Transplantation: A Systematic Review
Version: 0 Date: 26 Jan 2021
Reviewer's report:
The authors aimed to perform a systematic review of studies deriving and validating risk models
for pancreas transplant outcomes.  They found the majority of studies related primarily to
two risk indices: the P-PASS and the PDRI.  The P-PASS is a measure of surgeon behaviour
and determines the likelihood that a procured pancreas will be discarded based on donor
organ characteristics.  The PDRI is a model based on mostly donor demographic features and
determines the risk of 1 year graft failure in relation to that of the median donor.
Risk model deriving studies often did not report a discrimination statistic, or when reported
showed relatively poor discrimination.  The authors concluded that both P-PASS and PDRI have
been externally validated in specific populations but the quality of the studies was poor and
existing evidence does not allow extrapolation to further populations, specifically to the New
Zealand and Australian population.  The authors comment on the challenge of validating the
model in their population due to differences in covariate coding.
The authors have undertaken a large and time-consuming project and should be commended for
their efforts.  While neither model is used commonly in clinical practice, even in the populations
where it has been validated, the findings of this study do add to the literature.
Title: Risk Indices Predicting Graft use, Graft and Patient Survival in Solid Pancreas
Transplantation: A Systematic Review
Version: 0 Date: 26 Jan 2021
Reviewer's report:
The authors aimed to perform a systematic review of studies deriving and validating risk models
for pancreas transplant outcomes.  They found the majority of studies related primarily to
two risk indices: the P-PASS and the PDRI.  The P-PASS is a measure of surgeon behaviour
and determines the likelihood that a procured pancreas will be discarded based on donor
organ characteristics.  The PDRI is a model based on mostly donor demographic features and
determines the risk of 1 year graft failure in relation to that of the median donor.
Risk model deriving studies often did not report a discrimination statistic, or when reported
showed relatively poor discrimination.  The authors concluded that both P-PASS and PDRI have
been externally validated in specific populations but the quality of the studies was poor and
existing evidence does not allow extrapolation to further populations, specifically to the New
Zealand and Australian population.  The authors comment on the challenge of validating the
model in their population due to differences in covariate coding.
The authors have undertaken a large and time-consuming project and should be commended for
their efforts.  While neither model is used commonly in clinical practice, even in the populations
where it has been validated, the findings of this study do add to the literature.
Please review this paper.
user
Title: Risk Indices Predicting Graft use, Graft and Patient Survival in Solid Pancreas
Transplantation: A Systematic Review
Version: 0 Date: 26 Jan 2021
Reviewer's report:
The authors aimed to perform a systematic review of studies deriving and validating risk models
for pancreas transplant outcomes.  They found the majority of studies related primarily to
two risk indices: the P-PASS and the PDRI.  The P-PASS is a measure of surgeon behaviour
and determines the likelihood that a procured pancreas will be discarded based on donor
organ characteristics.  The PDRI is a model based on mostly donor demographic features and
determines the risk of 1 year graft failure in relation to that of the median donor.
Risk model deriving studies often did not report a discrimination statistic, or when reported
showed relatively poor discrimination.  The authors concluded that both P-PASS and PDRI have
been externally validated in specific populations but the quality of the studies was poor and
existing evidence does not allow extrapolation to further populations, specifically to the New
Zealand and Australian population.  The authors comment on the challenge of validating the
model in their population due to differences in covariate coding.
The authors have undertaken a large and time-consuming project and should be commended for
their efforts.  While neither model is used commonly in clinical practice, even in the populations
where it has been validated, the findings of this study do add to the literature.
assistant