Warm Ischemic Time as an Additive Predictor of Graft Survival in KDPI/KDRI Era of Kidneys from Donors After Cardiac Death: A Single-Center Experience Over Three Decades.
1Urology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
2Division of Medical Statistics, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
3Organ Transplant Surgery, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
Meeting: 2017 American Transplant Congress
Abstract number: C30
Keywords: Donors, Ischemia, Kidney transplantation, non-heart-beating, Warm ischemia
Session Information
Session Name: Poster Session C: Deceased Donor Issues II: DCD, DGF, AKI, En-Bloc
Session Type: Poster Session
Date: Monday, May 1, 2017
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall D1
It is important to predict the outcome of grafts prior to kidney transplantation and establish an appropriate allocation system, particularly to consider expanded criteria donors from donors after cardiac death (DCD). This study evaluated the validity of the KDPI/KDRI for Japanese DCD and compared it with other risk factors. 541 kidneys were retrieved from DCD donors. A total of 315 grafts were retrospectively assessed for the KDPI/KDRI and compared with other clinical factors. Results: The median follow-up period was 11.9 years. The value of the KDPI had a markedly asymmetric distribution (mean of 84% vs. median of 94%). The value of the KDRI distributed high index rates (0.79-2.94: median 1.70). The overall 1-, 5-, 10- and 15-year graft survivals were 87.1%, 67.5%, 52.1% and 38.9%, respectively. The KDRI level correlated with the long-term graft survival. The 1-, 5-, 10- and 15-year graft survivals of the KDPI<1.2 were 98.0%, 87.7%, 73.5% and 59.2% vs. KDRI>2.0 of 81.3%, 55.0%, 34.7% and 22.1%. The warm ischemic time (WIT), donor gender and the era of transplantation were also assessed as potential risk factors for graft loss. A WIT was identified as an independent risk factor for graft loss (p<0.001). Furthermore, the addition of the WIT > 30 min to a prediction model based on the established KDR risk factors had effect on model discrimination as measured by the C-index (0.708, 95% CI 0.636–0.780 to 0.731, 95% CI 0.660–0.803, p = 0.032).
| C-index (95%CI) | P value | NRI | P value | IDI | P value | |
| KDRI factors | 0.708 (0.636-0.780) | reference | reference | reference | ||
| +WIT | 0.727 (0.654-0.801) | 0.12 | 0.281 | 0.031 | 0.040 | 0.0020 |
| + WIT > 30min | 0.731 (0.660-0.803) | 0.032 | 0.256 | 0.0039 | 0.042 | 0.0022 |
Renal grafts recovered from DCD donors have a good renal function with an excellent long-term graft survival. The KDPI/KDRI is a good prognostic tool for the graft outcomes even for Japanese DCD. However, the WIT should also be included in the allocation system for DCD.
CITATION INFORMATION: Kusaka M, Kubota Y, Takahashi H, Sasaki H, Takenaka M, Fukami N, Kenmochi T, Shiroki R, Hoshinaga K. Warm Ischemic Time as an Additive Predictor of Graft Survival in KDPI/KDRI Era of Kidneys from Donors After Cardiac Death: A Single-Center Experience Over Three Decades. Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Kusaka M, Kubota Y, Takahashi H, Sasaki H, Takenaka M, Fukami N, Kenmochi T, Shiroki R, Hoshinaga K. Warm Ischemic Time as an Additive Predictor of Graft Survival in KDPI/KDRI Era of Kidneys from Donors After Cardiac Death: A Single-Center Experience Over Three Decades. [abstract]. Am J Transplant. 2017; 17 (suppl 3). https://atcmeetingabstracts.com/abstract/warm-ischemic-time-as-an-additive-predictor-of-graft-survival-in-kdpikdri-era-of-kidneys-from-donors-after-cardiac-death-a-single-center-experience-over-three-decades/. Accessed May 25, 2025.« Back to 2017 American Transplant Congress