KDPI summarizes the risk of donor kidney graft failure based on clinical and demographic parameters. We hypothesize that discard of a kidney with low KDPI should be rare and should reflect a reason other than kidney quality.

We obtained UNOS data on all discarded kidneys from January 1, 2007 to March 31, 2012. We divided the discard reasons by KDPI quintiles. We compared number and reasons for discard across KDPI quintiles. The top four reasons for kidney discards in each quintile are highlighted below.

The number of kidneys discarded increased with each KDPI quintile. 56.55% of discarded kidneys were in the highest quintile, KDPI 0.8 – 1.0.

The most common reason for discard of kidney with a KDPI < 0.4 is "Other". "Other" remained a commonly cited reason for discard across all higher quintiles. When KDPI < 0.20, "Organ Trauma" and "Anatomy" were common reasons for discard. In the higher quintiles, "Biopsy", "List Exhausted" and "Poor Organ Function" were more frequently used reasons for discard.

The most common "Other" reasons for discard are shown below.

The category "Other" was commonly used to communicate multiple or specific reasons for kidney discard not available in the drop-down menu on DonorNet. There was a total of 1.34 discard reasons per discarded kidney. "Pump Results" was the most common reason written-in. Hemorrhage/Hematoma was the more common reason if KDPI <0.2.

In summary, fewer kidneys are discarded in lower KDPI quintiles. "Biopsy" and "Other" are common reasons for discard in all quintiles. Kidneys with low KDPI are discarded for "Anatomy", "Organ Trauma", and "Hemorrhage/Hematoma" more often than in higher KDPI quintiles. Discard reasons in the higher quintiles reflect poorer kidney quality.

« Back to 2013 American Transplant Congress