Current US allocation system for kidney transplantation (KT) is based on KDRI (Kidney Donor Risk Index). In Brazil, it is still based on HLA-compatibility; donor characterization is restricted to the dichotomy of standard (SCD) or expanded criteria donor (ECD). This study aimed to analyze KDRI power to predict graft failure in a brazilian population. All 1224 deceased donor KT in the 2005-2014 period in a single center were considered. Exclusion criteria: recipient's age <18 years, multiorgan transplant, missing/invalid donor height or weight and previous KT. Final analysis included 942 patients; mean follow-up time was 1093 days (±910). Recipient's mean age was 50 years (±12.8), 52.4% male, 26.5% black, 20.6% diabetic nephropathy, 25.9% sensitized, 15.7% vascular access failure; mean dialysis time was 54.2 months (±44). Donor's mean age was 46.4 years (±130), of which 31.3% were ECD, and stroke was the cause of death in 59.8%. There were no cardiac-death, HCV+ donors, double nor en-bloc kidneys. Median KDRI was 1.31 (higher then in Rao study, 1,05); 6.2% of patients were in the original 1^st “quintile” (KDRI <0.79) and 35.7% in the 5^th “quintile” (KDRI>1.45). ECD and SCD kidneys distribution through KDRI ranges demonstrated that some ECD kidneys have reasonably good estimated quality likewise as SCD kidneys. A crude Cox regression was performed with all KDRI compounding (plus recipient) factors and adjusted Cox regression proved to be independently associated with graft failure: stroke as cause of death (HR 1.24, CI95% 1.03-1.38), DR-MM (HR 1.22, 1.03-1.43) and donor age (for each year: HR 1.02, 1.01-1.03). Extreme quintiles graft survival in 5 years were significant different (Log Rank, p<0.05) . KDRI ability to discriminate graft loss summarized in C-statistics 0.62 (CI95% 0.59-0.66) was very similar to the original study (0.60). In conclusion, the development of our own donor risk index based in our population might be the future for allocation and a helpful tool in kidney acceptance decision making.

CITATION INFORMATION: Reusing Jr. J, Nihei C, Lino de Souza A, David-Neto E, Ventura C. Original KDRI Predicts Kidney Graft Failure in a Brazilian Cohort. Am J Transplant. 2016;16 (suppl 3).

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