Association of Kidney Donor Risk Index with the Outcome after Kidney Transplantation in the Eurotransplant Senior Program

Abstract

BACKGROUND We evaluated the Kidney Donor Risk Index (KDRI) scoring system for kidney transplantation in the Eurotransplant Senior Program (ESP) that allocates kidneys from older donors to older recipients (≥65 years). MATERIAL AND METHODS We retrospectively analyzed data of 37 kidney transplant recipients and 36 kidney donors who participated in kidney transplantation program according to the ESP at our center from January 2004 until December 2013. RESULTS Mean recipient and donor age was 67.9±2.6 and 70.5±4.0 years respectively. The mean KDRI score was 1.7±0.27. Uncensored graft survival after 1 year and 5 years was 64.2% and 53.7% respectively. Subgroup analysis showed that in kidney transplantation with KDRI >1.83, graft survival was significantly reduced compared to lower KDRI subgroups. KDRI was significantly correlated with serum creatinine level at discharge (r=0.4). CONCLUSIONS ESP kidneys represent a group of high-risk grafts with high KDRI scores. Higher KDRI scores in ESP kidneys was associated with reduced postoperative short-term and long-term graft outcomes. KDRI might be useful in decision-making for selecting donors for ESP kidney transplantation.

Figure 1

Distribution of Kidney Donor Risk Index in Eurotransplant Senior Program kidneys.

Figure 2

Correlation of Kidney Donor Risk Index (KDRI) and creatinine at discharge. There was a positive correlation of the KDRI with the serum creatinine of the recipients at discharge after kidney transplantation according to the European Senior Program.

Figure 3

(A) Kaplan-Meier plots of patient survival by smoking status of the patients. Patient survival was decreased in smokers versus non-smokers. (B) Kaplan-Meier plots of death-censored graft survival by smoking status of the donor. Graft survival was reduced in donors with a history of smoking. (C) Kaplan-Meier plots of death-censored graft survival in 3 different Kidney Donor Risk Index (KDRI) subgroups [1.16–1.54 (n=12); 1.55–1.82 (n=11);1.83–2.26 (n=14)] showed a trend towards reduced death-censored graft survival in donors with a KDRI above 1.83. However, death-censored graft survival did not differ significantly between the 3 subgroups. (D) Kaplan Meier plots of uncensored graft survival in 3 different KDRI subgroups [1.1–1.54 (n=12); 1.55–1.82 (n=11); 1.83–2.26 (n=14)] showed that uncensored graft survival was reduced in donors with a KDRI above 1.83.