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

  Yes No Unknown
Recipient age:
HCV antibody positive?
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?
Primary insurance:
Recipient history of diabetes?
Recipient ethnicity:
Recipient history of COPD?
Dialysis modality pretransplant:
Recipient BMI (kg/m2):
Most recent panel-reactive antibody (PRA):
Recipient sex:
Limitations in ADLs:
Yes No Unknown
Donor age:
Donor history of hypertension?
Donor cause of death:
Donor history of diabetes?
Number of HLA (A, B, and DR) mismatches:
Donor HCV antibody positive?
Cold ischemia time (hours):
Crossmatch positive?
Donor race:
Donation after cardiac death?
Donor terminal serum creatinine (mg/dL):
Donor sex:
Donor-recipient CMV Seromatching: