Discard of Kidneys at the Margin: ECD Versus KDPI Era
Johns Hopkins, Baltimore, MD.
Meeting: 2015 American Transplant Congress
Abstract number: 46
Keywords: Allocation, Public policy
Session Information
Session Name: Concurrent Session: Kidney Utilization/Center Issues
Session Type: Concurrent Session
Date: Sunday, May 3, 2015
Session Time: 2:15pm-3:45pm
Presentation Time: 3:15pm-3:27pm
Location: Room 121-AB
BACKGROUND: Since 3/26/2012, the Kidney Donor Profile Index (KDPI), a percentile score reflecting donor-associated risk, has been provided with all deceased-donor kidney offers. We investigated whether discard rates changed after KDPI implementation.
METHODS: We studied kidneys recovered for transplantation between 3/26/2010-3/25/2012 (ECD era, N=28,636) and 3/26/2012-3/25/2014 (KDPI era, N=28,999) using SRTR data. We separately analyzed ECD-KDPI discordant kidneys, which were defined as ECD kidneys with KDPI≤75 (ECD/low-KDPI) or SCD kidneys with KDPI>85 (SCD/high-KDPI).
RESULTS: Both ECD and KDPI were associated with discard rate in both eras (Figure), but ECD was not significantly associated with discard when adjusted for KDPI. (OR=0.981.101.24, ECD era; 0.820.931.05, KDPI era) Using a generalized estimating equation, we did not observe a significant change in discard rate from ECD era to KDPI era among the entire population (aOR=0.981.041.10, p=0.2), or in any of the KDPI strata or the concordant kidneys. However, SCD/high-KDPI showed a significantly increased odds of discard (aOR=1.071.421.89, p=0.02) and ECD/low-KDPI showed a suggestive but not statistically significant decrease (aOR=0.570.771.04, p=0.1, Table).
CONCLUSION: Although the KDPI policy had minimal influence on overall discard, it may have increased the discard of SCD/high-KDPI kidneys. Special attention needs to be paid to this subgroup in organ allocation and clinical practice.
| ECD era (2010-2012) | KDPI era (2012-2014) | p-value | ||||
| N | Discard rate | N | Discard rate | aOR | ||
| Overall | 28,636 | 18.1% | 28,999 | 18.4% | 0.981.041.10 | 0.2 |
| Quintiles | ||||||
| KDPI 0-20 | 5,826 | 2.4% | 5,889 | 2.6% | 0.771.021.36 | 0.9 |
| KDPI 21-40 | 5,846 | 5.2% | 5,836 | 5.8% | 0.871.061.30 | 0.6 |
| KDPI 41-60 | 5,668 | 11.9% | 5,977 | 12.0% | 0.840.971.12 | 0.6 |
| KDPI 61-80 | 5,593 | 22.2% | 5,771 | 22.8% | 0.921.031.16 | 0.6 |
| KDPI 81-100 | 5,703 | 49.6% | 5,526 | 50.6% | 0.961.071.18 | 0.2 |
| Highest- & lowest-risk | ||||||
| KDPI 0-5 | 1,360 | 1.8% | 1,490 | 1.1% | 0.260.541.14 | 0.1 |
| KDPI 96-100 | 1,496 | 69.0% | 1,352 | 71.6% | 0.861.061.31 | 0.6 |
| ECD-KDPI concordance | ||||||
| SCD & KDPI>85 | 643 | 46.2% | 627 | 50.7% | 1.071.421.89 | 0.02 |
| ECD & KDPI≤75 | 1,018 | 23.2% | 899 | 19.1% | 0.570.771.04 | 0.1 |
| Concordant | 26,975 | 17.3% | 27,473 | 17.6% | 0.981.041.11 | 0.2 |
To cite this abstract in AMA style:
Bae S, Massie A, Segev D. Discard of Kidneys at the Margin: ECD Versus KDPI Era [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/discard-of-kidneys-at-the-margin-ecd-versus-kdpi-era/. Accessed November 24, 2024.« Back to 2015 American Transplant Congress