Validation of the Kidney Donor Profile Index (KDPI) to assess a deceased donor's kidneys' outcome in a European cohort

Abstract

The Kidney Donor Profile Index (KDPI) was introduced in the United States in 2014 to guide the decision making of clinicians with respect to accepting or declining a donated kidney. To evaluate whether the KDPI can be applied to a European cohort, we retrospectively assessed 580 adult patients who underwent renal transplantation (brain-dead donors) between January 2007 and December 2014 at our center and compared their KDPIs with their short- and long-term outcomes. This led to the observation of two associations: one between the KDPI and the estimated glomerular filtration rate at one year (1-y-eGFR) and the other between the KDPI and the death-censored allograft survival rate (both p < 0.001). Following this, the individual input factors of the KDPI were analyzed to assess their potential to evaluate the quality of a donor organ. We found that a donor's age alone is significantly predictive in terms of 1-y-eGFR and death-censored allograft survival (both p < 0.001). Therefore, a donor's age may serve as a simple reference for future graft function. Furthermore, we found that an organ with a low KDPI or from a young donor has an improved graft survival rate whereas kidneys with a high KDPI or from an older donor yield an inferior performance, but they are still acceptable. Therefore, we would not encourage defining a distinct KDPI cut-off in the decision-making process of accepting or declining a kidney graft.

Figure 1

KDPI distribution across the examined cohort.

Figure 2

Means of 1-y-eGFR for KDPI categories. 1-y-eGFR decreases with higher KDPI.

Figure 3

Means of 1-y-eGFR for donor age categories. 1-y-eGFR decreases with higher donor age.

Figure 4

Kaplan-Meier curves for death-censored allograft survival by KDPI-categories. p- values of log-rank-Test: <35% vs 35–85% p = 0.116. 35–85% vs >85% p = 0.003. <35% vs >85% p < 0.001.

Figure 5

Kaplan-Meier curves for death-censored allograft survival by donor age categories. p-values of log-rank-Test: <40 vs 40–60 years p = 0.194. 40–60 vs >60 years p < 0.001. <40 vs >60years p = 0.011.

Figure 6

Scatter of KDPI and donor age. Scatter-plot illustrating the correlation of KDPI and donor age.