Background: Rao et al have previously developed a kidney donor risk index (KDRI) and reported the application of KDRI as a predictor of graft failure using SRTR data. A modification of the KDRI that excludes transplant characteristics unknown at the time of an initial deceased donor (DD) kidney offer (HLA B mismatch, HLA DR mismatch, cold ischemia time, en bloc or double kidney transplantation) is used to calculate the kidney donor profile index (KDPI) that is now reported on the UNOS DonorNet website. This information is meant to aid clinicians with their decision making when considering acceptance and allocation of DD kidneys. In this study we calculated the KDRI for a cohort of DDs and examined its relationship to early and later organ function and survival. Results: Complete donor data necessary for KDRI calculation was available for 325 DDs that resulted in 523 kidney transplants with a mean follow up of 4.55 ± 2.14 years. The KDRI was calculated as described by UNOS and ranged from 0.66 to 2.98 (1.03 ± 0.40). KDRI, but neither ECD donor status nor cold ischemia time, was found to be a significant predictor of delayed graft function (DGF)(HR=3.3, CI 1.7-6.4) as well as graft failure at 6 months (HR=2.1, CI 1.0-4.6), 12 months (HR=2.2, CI 1.1-4.2), 24 months (HR=2.1, CI 1.2-3.8), and 5 years (HR=3.0, CI 1.4-6.4) by logistic regression. By simple linear regression there was a statistically significant positive linear relationship between the KDRI value and recipient serum creatinine at 5 (p<0.001), 14 (p=0.001), 30 (p=0.01), and 120 (p=0.001), but not 365 (p=0.07) days post-transplant. The rate of graft loss stratified by KDRI quintiles is presented in the table below.
|Graft Loss Rate||1||2||3||4||5|
|6 Months (n=523)||1.9%||7.6%||9.6%||9.4%||6.7%|
|12 Months (n=523)||5.8%||7.6%||11.5%||14.2%||10.6%|
|24 Months (n=462)||12.0%||11.2%||21.3%||22.0%||18.5%|
|5 Years (n=201)||23.6%||30.0%||28.1%||41.9%||51.6%|
Conclusions: KDRI calculated solely on the basis of donor characteristics correlates extremely well with kidney function and loss within the first post-transplant year, as well as 2 and 5 year graft loss. In multiple variable analysis donor KDRI, but not ECD status, was a significant independent predictor of DGF and graft loss.
To cite this abstract in AMA style:Pelletier R, Henry M. KDRI Accurately Predicts Early Post-Transplant Kidney Function and Survival, as Well as Late Survival [abstract]. Am J Transplant. 2013; 13 (suppl 5). http://atcmeetingabstracts.com/abstract/kdri-accurately-predicts-early-post-transplant-kidney-function-and-survival-as-well-as-late-survival/. Accessed November 24, 2017.
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