Introduction: Recently, a risk index for living donor kidney transplantation (LKDPI) was proposed (Massie et al. AJT 2016) to compare living donor kidneys (LDK) to each other and to deceased donor kidneys. Until now, the LKDPI has not been validated externally.

Methods: This long-term retrospective analysis included 1305 consecutive adult kidney transplant recipients, who were transplanted 2000-2016 in our center and had donor and recipient characteristics determined at time of transplantation. KDPI was calculated in 889 deceased donor kidneys, LKDPI in 416 LDK. Outcome was followed over a median of 6.5 years.

Results: The median LKDPI was 17, while the median KDPI was 69 with a high proportion of donor kidneys with a high KDPI (40% KDPI ≥80) (Fig.1a). LDK showed a significant better death censored graft survival (Fig.1b). Categorization of LDK into LKDPI subgroups (LDKPI<0, 0-20, 20-40 and >40) revealed no significant difference in death censored graft survival (after 10 years 84% vs. 85% vs. 89% vs. 67%, respectively, p=0.323). Without reaching statistically significance, there was a tendency for poorer graft survival for kidneys with LKDPI>40 (Fig.1c). Analyzing the all cause graft loss showed similar results (Fig.1d). Comparing corresponding subgroups of LKDPI and KDPI (LKDPI/KDPI 0-20 or 20-40) showed comparable graft survival (Fig.1e). In Cox regression models KDPI (HR 1.15; p<0.001) and age of the living kidney donor (HR1.03; p=0.046), but not LKDPI (HR 1.11; p=0.100) were significantly associated with the risk of graft loss. A multivariate model adjusted for recipient characteristics assessed by the EPTS score revealed KDPI (HR 1.17; p<0.001) but not LKDPI (HR 1.11; p=0.135) as a significant independent predictor of graft loss. ROC analyses for graft survival demonstrated lower predictive discrimination of the LKDPI (AUC 0.55) compared to the KDPI (AUC 0.66) (Fig.1f).

Conclusion: These results provide some evidence for the comparability of LKDPI to KDPI regarding posttransplant outcome, but our data suggest limited benefit of the LKDPI for the prognosis of graft survival in this European cohort.

CITATION INFORMATION: Staeck O, Rehse G, Khadzhynov D, Kleinsteuber A, Lehner L, Duerr M, Budde K, Halleck F. Assessment of the Risk Index for Living Donor Kidney Transplantation (LKDPI) in a European Cohort. Am J Transplant. 2017;17 (suppl 3).

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