Date: Sunday, June 12, 2016
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Halls C&D
Introduction: Delayed graft function (DGF) is the need for dialysis within the first 7 days after kidney transplantation. Immunologic and non-immunologic donor and recipient factors are associated with an increased risk of DGF. In 2014, the transplant community adopted a new allocation system based on kidney donor profile index (KDPI). The aim of our study is to better understand the association between DGF and KDPI.
Methods: An IRB-approved single center retrospective chart review was performed from 1/1999-7/2013. 2161 kidney transplants were included. The patients were divided into 6 groups: DBD KDPI≤60, DBD KPDI 61-84, DBD KDPI≥85, DCD KDPI≤60, DCD KPDI 61-84, and DCD KDPI≥85. Rates of DGF were calculated for each group. After controlling for cold ischemia time, odds ratios (OR) and hazards ratios (HR) were calculated to compare each group with the most favorable deceased donor kidney (DBD KDPI≤60).
Results: The rates of DGF were 18.7% for DBD KDPI≤60, 29% for DBD KPDI 61-84, 31.5% for DBD KDPI≥85, 45.1% for DCD KDPI≤60, 49.1% for DCD KPDI 61-84, and 49.1% for DCD KDPI≥85. After controlling for cold ischemia time, odds ratios showed an increase chance of DGF in recipients with higher KDPI and DCD organs. Similarly, hazard ratios indicate an decrease in graft survival with increasing KDPI.
Odds Ratios for DGF compared to DBD KDPI 0-60 kidney
|Group||Odds Ratio||95% CI||P-value|
|DBD KDPI 0-60||1||n/a||n/a|
|DBD KDPI 61-84||1.806||1.380 to 2.364||<.0001|
|DBD KDPI ≥ 85||2.050||1.372 to 3.063||<.0001|
|DCD KDPI 0-60||4.115||3.126 to 5.418||0.0005|
|DCD KDPI 61-84||4.834||3.401 to 6.871||<.0001|
|DCD KDPI ≥ 85||6.313||3.248 to 12.270||<.0001|
|Hazards Ratio for Graft Failure compared to DBD KDPI 0-60 kidney||1||n/a||n/a|
|DBD KDPI 0-60||1.588||1.356 to 1.860||<.0001|
|DBD KDPI 61-84||2.270||1.822 to 2.828||<.0001|
|DBD KDPI ≥ 85||0.935||0.754 to 1.161||0.5447|
|DCD KDPI 0-60||1.636||1.297 to 2.063||<.0001|
|DCD KDPI 61-84||1.881||1.234 to 2.868||0.0033|
|DCD KDPI ≥ 85|
Conclusion: When analyzing rates of DGF using the KDPI system, increasing KDPI correlates with a higher likelihood of DGF. Although KDPI is a predictor of DGF, DCD status has a much stronger association with increased rates DGF in transplant patients. As a result, DCD recipients are an ideal patient population for novel recipient treatment strategies to prevent DGF.
CITATION INFORMATION: Zens T, Leverson G, Redfield R, Chlebeck P, Zitur L, Kaufman D, Fernandez L. The Impact of Kidney Donor Profile Index (KDPI) on Rates of Delayed Graft Function (DGF). Am J Transplant. 2016;16 (suppl 3).
To cite this abstract in AMA style:Zens T, Leverson G, Redfield R, Chlebeck P, Zitur L, Kaufman D, Fernandez L. The Impact of Kidney Donor Profile Index (KDPI) on Rates of Delayed Graft Function (DGF). [abstract]. Am J Transplant. 2016; 16 (suppl 3). http://atcmeetingabstracts.com/abstract/the-impact-of-kidney-donor-profile-index-kdpi-on-rates-of-delayed-graft-function-dgf/. Accessed September 26, 2017.
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