Purpose: The kidney donor risk index (KDRI), developed by the United States Scientific Registry of Transplant Recipients (SRTR), was designed to quantify donor kidney quality. It has not been externally validated. We aimed to validate the KDRI in the Australian and New Zealand kidney transplant population.

Methods: Using data from the Australia and New Zealand Organ Donor (ANZOD) and Australia and New Zealand Dialysis and Transplant (ANZDATA) Registries, we included all adult deceased donor kidney-only transplants over 2002-2013. The KDRI was calculated using the SRTR formula (including donor age, hypertension, diabetes, terminal creatinine, cause of death, height, weight, donation after circulatory death (DCD) status and hepatitis C status). We constructed three Cox models: (1) KDRI only; (2) model 1 plus transplant characteristics (HLA mismatch, ischemic time, peak PRA and era); (3) model 2 plus recipient characteristics (age, sex, race, primary kidney disease, graft number, dialysis time, diabetes, coronary artery disease, peripheral vascular disease, cerebrovascular disease, chronic lung disease). The primary outcome was death-censored graft survival. Models were compared using Harrell's C statistics.

Results: KDRI was strongly associated with death-censored graft survival (p<0.0001 in all models). All models demonstrated moderately good discrimination, with Harrell's C statistics (95% CI) of 0.63 (0.60, 0.65), 0.67 (0.65, 0.70) and 0.69 (0.67, 0.72) respectively.

Conclusion: The KDRI performed moderately well at discriminating deceased donor kidney quality in the Australian and New Zealand population.

CITATION INFORMATION: Clayton P, White S, McDonald S, Chadban S. Validation of the Kidney Donor Risk Index (KDRI) in the Australian and New Zealand Kidney Transplant Population. Am J Transplant. 2016;16 (suppl 3).

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