Development and external validation study combining existing models and recent data into an up-to-date prediction model for evaluating kidneys from older deceased donors for transplantation

With a rising demand for kidney transplantation, reliable pre-transplant assessment of organ quality becomes top priority. In clinical practice, physicians are regularly in doubt whether suboptimal kidney offers from older donors should be accepted. Here, we externally validate existing prediction models in a European population of older deceased donors, and subsequently developed and externally validated an adverse outcome prediction tool. Recipients of kidney grafts from deceased donors 50 years of age and older were included from the Netherlands Organ Transplant Registry (NOTR) and United States organ transplant registry from 2006-2018. The predicted adverse outcome was a composite of graft failure, death or chronic kidney disease stage 4 plus within one year after transplantation, modelled using logistic regression. Discrimination and calibration were assessed in internal, temporal and external validation. Seven existing models were validated with the same cohorts. The NOTR development cohort contained 2510 patients and 823 events. The temporal validation within NOTR had 837 patients and the external validation used 31987 patients in the United States organ transplant registry. Discrimination of our full adverse outcome model was moderate in external validation (C-statistic 0.63), though somewhat better than discrimination of the seven existing prediction models (average C-statistic 0.57). The model's calibration was highly accurate. Thus, since existing adverse outcome kidney graft survival models performed poorly in a population of older deceased donors, novel models were developed and externally validated, with maximum achievable performance in a population of older deceased kidney donors. These models could assist transplant clinicians in deciding whether to accept a kidney from an older donor

Soil organic carbon dynamics under long-term fertilizations in arable land of northern China

Soil carbon sequestration is a complex process influenced by agricultural practices, climate and soil conditions. This paper reports a study of long-term fertilization impacts on soil organic carbon (SOC) dynamic from six long-term experiments. The experiment sites are located from warm-temperate zone with a double-cropping system of corn (Zea mays L.) - wheat (Triticum Aestivium L.) rotation, to mild-temperate zones with mono-cropping systems of continuous corn, or a three-year rotation of corn-wheat-wheat. Mineral fertilizer applications result in an increasing trend in SOC except in the arid and semi-arid areas with the mono-cropping systems. Additional manure application is important to maintain SOC level in the arid and semi-arid areas. Carbon conversion rate is significant lower in the warm-temperate zone with double cropping system (6.8%-7.7%) than that in the mild-temperate areas with mono-cropping systems (15.8%-31.0%). The conversion rate is significantly correlated with annual precipitation and active accumulative temperature, i.e., higher conversion rate under lower precipitation and/or temperature conditions. Moreover, soil high in clay content has higher conversion rate than soils low in clay content. Soil carbon sequestration rate ranges from 0.07 to 1.461 t ha(-1) year(-1) in the upland of northern China. There is significantly linear correlation between soil carbon sequestration and carbon input at most sites, indicating that these soils are not carbon-saturated thus have potential to migrate more CO2 from atmosphere