Background: Deceased donor (DD) kidney quality is now being determined by calculating the Kidney Donor Profile Index (KDPI). Calculated kidney vascular resistance index (RI) during PP provides another parameter used to determine organ quality. We performed this study to explore the relationship between KDPI and PP resistance and thus enhance our ability to use these parameters for kidney allocation optimization.

Results: DD characteristics enabling KDRI calculation and the calculated PP RI were available for 1084 kidney and kidney/pancreas recipients transplanted between 1/1996 and 11/2011. The KDRI mean was 1.193714388 with a median of 1.113118882 (range 0.6187091423 to 3.093045377). KDPI ≥ 85% was determined using the OPTN KDRI to KDPI mapping table (reference population of all 2013 US deceased donors). 207 (19.1%) of transplanted kidneys were obtained from KDPI ≥ 85% donors (HiKDPI group) and 877 kidneys were from KDPI < 85% donors (LowKDPI group). The mean RI was 0.2312 with a median of 0.2200. The mean RI was significantly higher for the HiKDPI versus the LowKDPI group (0.2651 vs 0.2228, p<0.001). 83/1084 (7.7%) of all transplants developed DGF defined as dialysis within the first post-transplant week. Both HiKDPI and high RI (≥ 0.30) correlated with DGF in univariate analyses (p<0.001). In multivariable regression analysis both HiKDPI and RI ≥ 0.30 were independent correlates with DGF (HR 2.8 [CI 1.7-4.5] and 2.5 [CI1.5-4.1] respectively. Recipients were grouped by KDPI and RI status and DGF determined for each group:

Conclusion: KDPI and PP RI are independent predictors of post-transplant DGF and early renal function. Both parameters should be considered when determining optimum kidney allocation.

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