A New Risk Stratification Scoring System for Deceased Donor Kidneys and Suitable Candidates for Marginal Kidneys in Korea
1Transplantation Center, Seoul National University Hospital, Seoul, Korea, Republic of, 2Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea, Republic of, 3Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea, Republic of
Meeting: 2019 American Transplant Congress
Abstract number: B172
Keywords: Allocation, Donors, marginal, Waiting lists
Session Information
Session Name: Poster Session B: Kidney Donor Selection / Management Issues
Session Type: Poster Session
Date: Sunday, June 2, 2019
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall C & D
*Purpose: The dichotomous criteria for expanded criteria donor (ECD) vs. standard criteria donor (SCD) have been useful for making decisions about accepting deceased donor kidney offers; however, several studies reported that these criteria are too simple to predict prognosis sufficiently. Recently, Kidney Donor Profile Index (KDPI) was introduced to the US; however it is uncertain that it has similar prognostic values in other countries. Here, we developed a Korean risk stratification scoring system for deceased donor kidney and investigated its prognostic values. Furthermore, we investigated who are suitable candidates for ECD kidneys in Korea.
*Methods: Based on the national data from the Korean Organ Network for Organ Sharing (KONOS), we analyzed 5,524 first-time, adult deceased donor kidney transplantation (KT) patients between 2000 and 2016. There were 426 deaths and 483 graft loss.
*Results: A Korean KDPI includes 5 donor factors, each found to be independently associated with graft failure: donor age, weight, history of diabetes, serum creatinine, and cerebrovascular cause of death. The lower K-KDPI group (<80%) showed better graft survival than the higher K-KDPI group (≥80%). Even within the ECD group, higher K-KDPI was associated with lower graft survival rate. These data suggested that K-KDPI is a better prognostic tool for graft outcomes than the previous ECD/SCD criteria. Next, we analyzed 19,392 candidates by using KONOS and National Health Insurance Service data from 2002 to 2015 to find out the criteria of suitable candidates for ECD kidneys. A total of 4,278 received ECD KT, 1,444 received SCD KT, and 13,670 had not received KT. Subgroups that showed survival benefits by receiving ECD kidneys with K-KDPI ≥90% compared to dialysis or receiving kidneys with K-KDPI <90%, included patients older than 40 years, those with diabetes or hypertension and short waiting time (<1,340 days). Therefore, advanced ECD KTs could be offered primarily to candidates older than 40 years in diabetes or hypertension with short waiting time.
*Conclusions: In conclusion, the new K-KDPI criteria and suitable candidate criteria for ECD from K-KDPI are expected to improve decision making for deceased donor kidney utilization in Korea.
To cite this abstract in AMA style:
Koo T, Ryu J, Park S, Lee S, Hwang J, Ahn C, Yang J. A New Risk Stratification Scoring System for Deceased Donor Kidneys and Suitable Candidates for Marginal Kidneys in Korea [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/a-new-risk-stratification-scoring-system-for-deceased-donor-kidneys-and-suitable-candidates-for-marginal-kidneys-in-korea/. Accessed May 9, 2025.« Back to 2019 American Transplant Congress