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. 2016 Jul;16(7):2077-84.
doi: 10.1111/ajt.13709. Epub 2016 Feb 26.

A Risk Index for Living Donor Kidney Transplantation

A B Massie  1   2 , J Leanza  1 , L M Fahmy  1 , E K H Chow  1 , N M Desai  1 , X Luo  1 , E A King  1 , M G Bowring  1 , D L Segev  1   2   3
Affiliations

A Risk Index for Living Donor Kidney Transplantation

A B Massie et al. Am J Transplant. 2016 Jul.

Erratum in

  • Erratum.
    [No authors listed] [No authors listed] Am J Transplant. 2020 Jan;20(1):324. doi: 10.1111/ajt.15727. Am J Transplant. 2020. PMID: 31894908 No abstract available.

Abstract

Choosing between multiple living kidney donors, or evaluating offers in kidney paired donation, can be challenging because no metric currently exists for living donor quality. Furthermore, some deceased donor (DD) kidneys can result in better outcomes than some living donor kidneys, yet there is no way to compare them on the same scale. To better inform clinical decision-making, we created a living kidney donor profile index (LKDPI) on the same scale as the DD KDPI, using Cox regression and adjusting for recipient characteristics. Donor age over 50 (hazard ratio [HR] per 10 years = 1.15 1.241.33 ), elevated BMI (HR per 10 units = 1.01 1.091.16 ), African-American race (HR = 1.15 1.251.37 ), cigarette use (HR = 1.09 1.161.23 ), as well as ABO incompatibility (HR = 1.03 1.271.58 ), HLA B (HR = 1.03 1.081.14 ) mismatches, and DR (HR = 1.04 1.091.15 ) mismatches were associated with greater risk of graft loss after living donor transplantation (all p < 0.05). Median (interquartile range) LKDPI score was 13 (1-27); 24.2% of donors had LKDPI < 0 (less risk than any DD kidney), and 4.4% of donors had LKDPI > 50 (more risk than the median DD kidney). The LKDPI is a useful tool for comparing living donor kidneys to each other and to deceased donor kidneys.

Keywords: clinical research/practice; graft survival; kidney transplantation/nephrology; kidney transplantation: living donor.

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Conflict of interest statement

DISCLOSURE

The authors of this manuscript have no conflicts of interest to disclose as described by the American Journal of Transplantation.

Figures

Figure 1
Figure 1
Distribution of LKDPI of transplanted living donor kidneys (solid line) and KDPI of transplanted deceased donor kidneys (dashed line). While the distribution of KDPI is roughly uniform across the range 0–100 by design, the LKDPI ranges from −77 to 110, with a median (IQR) score of 13 (−1 – 27). In other words, the median living donor kidney confers expected graft survival equivalent to a deceased donor kidney with KDPI of 13.
Figure 2
Figure 2
Cumulative all-cause graft loss in LDKT recipients, by category of LKDPI. Recipients with a higher LKDPI had higher risk of graft loss.
Figure 3
Figure 3
Cumulative all-cause graft loss in DDKT and LDKT recipients across strata of KDPI/LKDPI, in recipient populations matched on age, peak PRA, race, sex, and years on renal replacement therapy. Matching is necessary because LKDT recipients tend to be healthier than DDKT recipients. Within each stratum, graft loss is equivalent in DDKT and LDKT recipients, indicating that the KDPI and LKDPI risk scores are equivalent.
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References

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