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. 2016 Jul;16(7):2202-7.
doi: 10.1111/ajt.13769. Epub 2016 Mar 22.

Changes in Discard Rate After the Introduction of the Kidney Donor Profile Index (KDPI)

S Bae  1 , A B Massie  1   2 , X Luo  1 , S Anjum  1 , N M Desai  1 , D L Segev  1   2   3
Affiliations

Changes in Discard Rate After the Introduction of the Kidney Donor Profile Index (KDPI)

S Bae et al. Am J Transplant. 2016 Jul.

Abstract

Since March 26, 2012, the Kidney Donor Profile Index (KDPI) has been provided with all deceased-donor kidney offers, with the goal of improving the expanded criteria donor (ECD) indicator. Although an improved risk index may facilitate identification and transplantation of marginal yet viable kidneys, a granular percentile system may reduce provider-patient communication flexibility, paradoxically leading to more discards ("labeling effect"). We studied the discard rates of the kidneys recovered for transplantation between March 26, 2010 and March 25, 2012 ("ECD era," N = 28 636) and March 26, 2012 and March 25, 2014 ("KDPI era," N = 29 021) using Scientific Registry of Transplant Recipients (SRTR) data. There was no significant change in discard rate from ECD era (18.1%) to KDPI era (18.3%) among the entire population (adjusted odds ratio [aOR] = 0.97 1.041.10 , p = 0.3), or in any KDPI stratum. However, among kidneys in which ECD and KDPI indicators were discordant, "high risk" standard criteria donor (SCD) kidneys (with KDPI > 85) were at increased risk of discard in the KDPI era (aOR = 1.07 1.421.89 , p = 0.02). Yet, recipients of these kidneys were at much lower risk of death (adjusted Risk Ratio [aRR] = 0.56 0.770.94 at 2 years posttransplant) compared to those remaining on dialysis waiting for low-KDPI kidneys. Our findings suggest that there might be an unexpected, harmful labeling effect of reporting a high KDPI for SCD kidneys, without the expected advantage of providing a more granular risk index.

Keywords: clinical decision-making; clinical research/practice; kidney transplantation/nephrology; organ acceptance; organ procurement and allocation; patient education.

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Figures

Figure 1
Figure 1. Proportion of ECD kidneys by KDPI strata
ECD kidneys with KDPI≤85 and SCD kidneys with KDPI>85 were defined as discordant. ECD, expanded criteria donor; KDPI, Kidney Donor Profile Index; SCD, standard criteria donor.
Figure 2
Figure 2. Average discard rate, by Kidney Donor Profile Index (KDPI)
Both KDPI and ECD were associated with discard rate in ECD era (a) as well as KDPI era (b). The lines indicate lowess plots. The markers were sized proportionally to the number of kidneys each dot represents. ECD, expanded criteria donor; KDPI, Kidney Donor Profile Index.
Figure 2
Figure 2. Average discard rate, by Kidney Donor Profile Index (KDPI)
Both KDPI and ECD were associated with discard rate in ECD era (a) as well as KDPI era (b). The lines indicate lowess plots. The markers were sized proportionally to the number of kidneys each dot represents. ECD, expanded criteria donor; KDPI, Kidney Donor Profile Index.
Figure 3
Figure 3. Survival benefit of transplanting SCD kidneys with KDPI>85
The cumulative incidence of death among the SCD/high-KDPI recipients compared to those who remained on waitlist was higher immediately after transplant. However, the relative cumulative incidence decreased over time, reaching a “break-even point” at 1.20 years after transplant. ECD, expanded criteria donor; KDPI, Kidney Donor Profile Index; SCD, standard criteria donor.
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