There is no consensus of selection criteria used to allocate renal transplants from expanded criteria donors (ECD). The Kidney Donor Profile Index (KDPI) has been introduced to better allocate these allografts without the need of standardized pre-implantation kidney biopsies (PIKB) but with a discard rate of >40%. Aim: to explore if KDPI in combination with PIKB improves the acceptance rate of ECD with KDPI>91% and the outcomes at 5 years.

Retrospective observational study of 500 consecutive kidneys procured from 311 ECD from a single centre between 2000-2010 and accepted for transplantation if PIKB Remuzzi score was <4. The KDPI index was retrospectively calculated.

69 kidneys (15.8%) were discarded based on PIKB [KDPI<80(5.9%), KDPI81-90(12.2%), KDPI>91(19.7%)] and 57 kidneys were transplanted in other centers. Patient survival at 5y was 80.2%[KDPI<80(n11), KDPI81-90(n12), KDPI>91(n49)](p0.110). Death censored graft survival at 5y was 78.8%[KDPI<80(n12), KDPI81-90(n11), KDPI>91(n54)](p0.015. 42.5%(n23) in KDPI>91% group lost the graft due to chronic allograft nephropathy. There were no differences in the KDPI<91% group in the Remuzzi score (<4vs=4)(p0.294)

The implementation of standardized PIKB in ECD transplants with KDPI>91% range allows to identify suitable marginal kidneys for transplantation, reducing the discard rate to 19.2%, with good renal graft survival rate at 4 years.

CITATION INFORMATION: Sánchez-Escuredo A, Sagasta A, Diekmann F, Revuelta I, Rodas L, Paredes D, Musquera M, Esforzado N, Ricart M, Cofan F, Torregrosa V, Campistol J, Sole M, Oppenheimer F. Standardized Pre-Implantation Kidney Biopsies of Expanded Criteria Donors to Improve the Kidney Donor Profile Index (KDPI) for the Evaluation of Marginal Donors. Am J Transplant. 2016;16 (suppl 3).

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