Background: Kidney Donor Profile Index (KDPI) has been shown to be predictive of both short and long term graft survival and is used by transplant centers as the screening tool for donor quality. However, there are limited prospective reports on its predictive ability for short term renal function vs. recipient factors assessed by EPTS. We performed this analysis to explore the relationship between KDPI and eGFR to better understand its use in deceased donor kidney allocation.

Methods: All adult deceased donor kidney transplant recipient with at least 6 month graft survival from a single center institution between 2013 and 2015 were analyzed. eGFR was determined based on the MDRD at 6 months post-transplant. KDPI was calculated per UNOS criteria. Deceased donor and recipient pre and post-transplant parameters were analyzed by a multivariate linear regression to determine their impact on eGFR.

Results: 124 deceased donor recipients were identified with at least 6 month graft function with a mean follow up of 1.5±0.9 years. This analysis focused on adult donors; 3 pediatric en-bloc kidney recipients were excluded. The mean KDPI of these donors was 52±26 (range: 5-100) with mean eGFR of 57±20 ml/min/1.72m². KDPI and recipient BMI were the most important factors influencing 6 month eGFR. The drop in eGFR associated with increasing BMI was twice that of KDPI. Each 10 unit increase in KDPI resulted in an estimated drop in eGFR of 3.2 ml/min/1.72m². There were trends for known factors such as delayed graft function and cold ischemia time. Interestingly, highly sensitized patients who qualified for regional/national sharing may be predictive of an improved eGFR suggesting high quality organs are being allocated to this patient population. Recipient intrinsic factors as assessed by both EPTS and its individual components were non-relevant. Recipient demographics such as gender, race, or HLA-matching were also non-contributory.

Conclusions: KDPI and recipient BMI are independent predictors which significantly impact short term graft function. Though EPTS may correlate with graft survival, it has minimal utility in predicting eGFR. Therefore, KDPI should be considered when determining optimal organ utilization.

CITATION INFORMATION: Agarwal A, Ally W, Maluf D, Pelletier S, Brayman K. Kidney Donor Profile Index and Recipient BMI Are Potent Predictors of Six Month Deceased Donor eGFR as Opposed to EPTS. Am J Transplant. 2016;16 (suppl 3).

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