Predicted 5-Year Graft Survival, If Patient Survives for 1 Week

  Yes No Unknown
Recipient age:
Recipient history of smoking?
Recipient race:
Recipient history of CHF?
Years of RRT (if first transplant):
Recipient history of substance abuse?
Years of RRT (if subsequent transplant):
Recipient history
of hypertension?
Primary cause of CKD:
Recipient history of ASHD?
Discharge eGFR (ml/min/1.73m2) if no delayed graft function:
Recipient history of diabetes?
Discharge eGFR (ml/min/1.73m2) if delayed graft function:
Recipient HCV antibody positive?
Primary insurance:
Recipient ethnicity:
Dialysis modality:
Induction antibodies:
Most recent panel-reactive antibody (PRA):
Limitations in ADLs:
Yes No Unknown
Donor age:
Donor HCV antibody positive?
Donor race:
Donor history of diabetes?
Number of HLA (A, B, and DR) mismatches:
Donor history of hypertension?
Donor sex:
Donor-recipient CMV Seromatching:
Donor cause of death: