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Clinical Trial
. 2018 Mar;32(3):e13190.
doi: 10.1111/ctr.13190.

The impact of kidney donor profile index on delayed graft function and transplant outcomes: A single-center analysis

Tiffany J Zens  1 , Juan S Danobeitia  1 , Glen Leverson  2 , Peter J Chlebeck  1 , Laura J Zitur  1 , Robert R Redfield  1 , Anthony M D'Alessandro  1 , Scott Odorico  1 , Dixon B Kaufman  1 , Luis A Fernandez  1
Affiliations
Clinical Trial

The impact of kidney donor profile index on delayed graft function and transplant outcomes: A single-center analysis

Tiffany J Zens et al. Clin Transplant. 2018 Mar.

Abstract

Introduction: Renal transplant outcomes result from a combination of factors. Traditionally, donor factors were summarized by classifying kidneys as extended criteria or standard criteria. In 2014, the nomenclature changed to describe donor factors with the kidney donor profile index (KDPI). We aim to evaluate the relationship between KDPI and delayed graft function (DGF), and the impact KDPI on transplant outcomes for both donor after cardiac death (DCD) and donor after brain death (DBD).

Methods: An IRB-approved single-center retrospective chart review was performed from January 1999 to July 2013. The patients were divided into six groups: DBD KDPI ≤60, DBD KPDI 61-84, DBD KDPI ≥85, DCD KDPI ≤60, DCD KPDI 61-84, and DCD KDPI ≥85. Rates of DGF, patient survival, and graft survival were examined among groups.

Results: A total of 2161 kidney transplants were included. DGF rates increased, and graft and patient survival decreased with increasing KDPI (P < .001). DCD kidneys had higher DGF rates than their DBD counterparts (P < .001). In DCD kidneys, a higher KDPI score did not significantly affect the DGF rates (P > .302). There was no significant difference in graft or patient survival in all-comers when comparing DCD and DBD kidneys with equivalent KDPIs (P > .317). Patients with DGF across all categories demonstrated worse graft half-lives.

Conclusion: The KDPI system is an accurate predictor of donor contributions to transplant outcomes. Recipients of DBD kidneys experience an increase in the rate of DGF as their KDPI increases. DCD kidneys have higher DGF rates than their DBD counterparts with similar KDPIs. Patients with documented post-transplant DGF had between 3- and 5-year shorter graft half-lives when compared to recipients that did not experience DGF. Initiatives to reduce the rate of DGF could provide a significant impact on graft survival and result in a reduction in the number of patients requiring retransplant.

Keywords: DGF,; KDPI; classification systems; delayed graft function; donors and donation: deceased; graft survival; kidney donor profile index; kidney transplant.

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Conflict of interest statement

CONFLICT OF INTEREST

The authors declare no conflict of interest.

Figures

FIGURE 1
FIGURE 1
Graft survival: This Kaplan-Meier curve illustrates the kidney graft survival based on both DCD vs DBD and KDPI status with kidneys with higher KDPIs having poorer graft survival. DBD, donor after brain death; DCD, donor after cardiac death; KDPI, kidney donor profile index
FIGURE 2
FIGURE 2
Patient survival: This Kaplan-Meier curve illustrates the kidney graft survival based on both DCD vs DBD and KDPI status with kidneys with higher KDPIs having poorer patient survival. DBD, donor after brain death; DCD, donor after cardiac death; KDPI, kidney donor profile index
See this image and copyright information in PMC

References

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