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• Graft Survival - Year 1

Predicted 5-Year Graft Survival, Estimated on Day of Transplant

Yes No Unknown

Recipient age: Please Select 75 74 73 72 71 70 69 68 67 66 65 64 63 62 61 60 59 58 57 56 55 54 53 52 51 50 49 48 47 46 45 44 43 42 41 40 39 38 37 36 35 34 33 32 31 30 29 28 27 26 25 24 23 22 21 20 HCV antibody positive?

Recipient race: Please Select White African American Asian Other/Unknown Recipient history of CHF?

Years of RRT (if first transplant): Please Select Not first transplant Preemptive < 1 year 1 - < 3 years 3 - < 5 years 5+ years Recipient history of substance abuse?

Years of RRT (if subsequent transplant): Please Select First Transplant Subsequent, < 9 years Subsequent, 9 - 14 years Subsequent, 14+ years Recipient history of hypertension?

Primary cause of CKD: Please Select Diabetes Hypertension Glomerulonephritis Cystic Disease Other Recipient history of ASHD?

Primary insurance: Please Select Medicare Private Other Recipient history of diabetes?

Recipient ethnicity: Please Select Non-Hispanic Hispanic Recipient history of COPD?

Dialysis modality pretransplant: Please Select Hemodialysis Peritoneal Dialysis None Unknown

Recipient BMI (kg/m2): Calculate

Most recent panel-reactive antibody (PRA): Please Select 0% 1-19% 20-79% =>80% Unknown

Recipient sex: Please Select Male Female

Limitations in ADLs: Please Select Yes No

Yes No Unknown

Donor age: Please Select 71 70 69 68 67 66 65 64 63 62 61 60 59 58 57 56 55 54 53 52 51 50 49 48 47 46 45 44 43 42 41 40 39 38 37 36 35 34 33 32 31 30 29 28 27 26 25 24 23 22 21 20 19 18 17 16 15 14 13 12 11 10 9 8 7 6 5 4 3 2 Donor history of hypertension?

Donor cause of death: Please Select Trauma Other Donor history of diabetes?

Number of HLA (A, B, and DR) mismatches: Please Select 0 1-3 4-6 Unknown Donor HCV antibody positive?

Cold ischemia time (hours):   Crossmatch positive?

Donor race: Please Select White African American Asian Other/Unknown Donation after cardiac death?

Donor terminal serum creatinine (mg/dL):

Donor sex: Please Select Male Female

Donor-recipient CMV Seromatching: Please Select D+ and R- D+ and R+ D- and R+ D- and R-