Higher KDPI Predicts Lower Renal Allograft Function and Higher Interstitial Fibrosis and Tubular Atrophy at 6 Months
UCSF, San Francisco
Meeting: 2013 American Transplant Congress
Abstract number: D1521
Background
The Kidney Donor Profile Index (KDPI) estimates the risk of graft failure relative to all donors from the previous year, expressed as a cumulative percentage scale from 0.01 to 1. KDPI has been proposed as a decision tool in the allocation of deceased donor kidneys. Associations of KDPI with early graft function and pathology have not previously been studied.
Methods
Single center retrospective analysis of single deceased donor kidney transplants 2009-2011 for which clinical information and 6-month surveillance biopsy data were available. All biopsies were scored by the revised Banff 2007 classification. Linear regression was used to analyze associations of KDPI with MDRD eGFR. Logistic regression was used to analyze associations of KDPI with fibrosis and tubular atrophy. All models were refit using multiple regression adding potential confounders one at a time.
Results
206 deceased donor kidney transplants were analyzed. Recipient demographic/ transplant characteristics and 6-month biopsy data are listed in Table 1. Organ characteristics are listed in Table 2.
| Median age | 55 (21-81) yrs |
| Male | 127 (61.7%) |
| African-American | 40 (19.4%) |
| Diabetes | 81 (39.3%) |
| PRA >20% | 42 (20.4%) |
| Thymoglobulin induction | 122 (59.2%) |
| DGF | 67 (32.5%) |
| Early steroid withdrawal | 35 (17%) |
| 6 month MDRD eGFR | 66.1 |
| 6-month biopsy | |
| – ci (fibrosis) score ≥1 | 76 (36.9%) |
| – ct (atrophy) score ≥1 | 141 (68.4%) |
| Median donor age | 32 (2-68) yrs |
| Male | 130 (63.1%) |
| Category | |
| – Std criteria | 169 (82%) |
| – DCD | 15 (7.3%) |
| – ECD | 22 (10.7%) |
| Mean KDPI | 0.418 |
From linear regression, 6 month MDRD eGFR had a statistically significant negative association with KDPI score: estimated 2.93 ml/min/1.73 m2 reduction per 0.1 increase in KDPI (95% CI -3.88 to -1.98, p<0.0001). Higher KDPI was statistically significantly associated with increased risk of interstitial fibrosis (ci score ≥1) and tubular atrophy (ct score ≥1) on the 6-month biopsy. From logistic regression analysis the estimated odds ratio for a 0.1 unit increase in KDPI was 1.33 (95% CI 1.17 to 1.50, p<0.0001) for interstitial fibrosis and 1.22 (95% CI 1.08 to 1.39, p<0.0001) for tubular atrophy. These associations remained statistically significant with very similar effect estimates in multiple regression analysis (both linear and logistic).
Conclusion
KDPI predicts graft function and chronicity on kidney biopsies within the first year, supporting its potential use as a tool for organ allocation in schemes to maximize positive transplant outcomes.
To cite this abstract in AMA style:
Chandran S, Laszik Z, Hirose R, Freise C, Vincenti F. Higher KDPI Predicts Lower Renal Allograft Function and Higher Interstitial Fibrosis and Tubular Atrophy at 6 Months [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/higher-kdpi-predicts-lower-renal-allograft-function-and-higher-interstitial-fibrosis-and-tubular-atrophy-at-6-months/. Accessed November 22, 2024.« Back to 2013 American Transplant Congress