The Impact of Delayed Graft Function on Long Term Graft Survival Adjusted for Donor Kidney Quality Assessed by the KDPI.
Nephrology Charite Campus Mitte, Charite Universitaetsmedizin Berlin, Berlin, Germany
Meeting: 2017 American Transplant Congress
Abstract number: 516
Keywords: Cadaveric organs, Donors, Graft failure, marginal, Multivariate analysis
Session Information
Session Name: Concurrent Session: Kidney General Outcomes
Session Type: Concurrent Session
Date: Tuesday, May 2, 2017
Session Time: 4:30pm-6:00pm
Presentation Time: 4:30pm-4:42pm
Location: E354a
Introduction
Delayed graft function (DGF) is associated with impaired graft survival in kidney transplant recipients. The kidney donor profile index (KDPI) is increasingly evaluated as a prognostic tool to predict graft quality. However, there is few data that examined the contribution of DGF and donor kidney quality to impaired graft outcomes.
Methods
This retrospective single center study included 580 adult patients who received a deceased donor kidney from 2000-2010. KDPI was calculated using OPTN data as reference and long-term outcomes (mean 8.0 years) were assessed.
Results
Overall mean KDPI was 66%. Further categorization according to KDPI (<35% (n=99), 35-85% (n=264) and >85% (n=217) resulted in a very high mean KDPI of 95% in the group with the highest KDPI. Due to the nature of the European Senior Program (ESP) this group showed a significantly higher recipient age (64 years compared to 47 and 48 years in the <35% and 35-85% groups, respectively). As expected, at 10 years patients living with functioning graft (71.9%, 58.5%, 31.3%) and death censored graft survival (86.7%, 76.9%, 55.6%) decreased with increasing KDPI (Fig.1 a,b). Intriguingly, rates of DGF <35%: 35.4%, 35-85%: 50.0%, >85% 53.9%) did not increase proportionally with higher KDPI. This might represent the ESP driven effect by local allocation of kidneys >65 years in order to lower cold ischemia time. However, DGF had a significant negative effect on long term graft survival in all KDPI categories (Fig.1 c,d). A multivariate Cox regression analysis adjusted for KDPI and cold ischemia time revealed DGF as an independent risk factor for premature graft loss (HR 1.97, p<0.001).
Discussion
DGF contributes to further risk for graft loss indepently from donor kidney quality assessed by the KDPI and cold ischemia time. Very high KDPI kidneys (>85%) – mostly allocated within the Eurotransplant senior program, facilitating shorter cold ischemia time – achieved comparable rates of DGF to kidneys with a KDPI 35-85%. 
CITATION INFORMATION: Lehner L, Halleck F, Khadzhynov D, Schrezenmeier E, Dürr M, Budde K, Staeck O. The Impact of Delayed Graft Function on Long Term Graft Survival Adjusted for Donor Kidney Quality Assessed by the KDPI. Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Lehner L, Halleck F, Khadzhynov D, Schrezenmeier E, Dürr M, Budde K, Staeck O. The Impact of Delayed Graft Function on Long Term Graft Survival Adjusted for Donor Kidney Quality Assessed by the KDPI. [abstract]. Am J Transplant. 2017; 17 (suppl 3). https://atcmeetingabstracts.com/abstract/the-impact-of-delayed-graft-function-on-long-term-graft-survival-adjusted-for-donor-kidney-quality-assessed-by-the-kdpi/. Accessed November 22, 2024.« Back to 2017 American Transplant Congress