117.5: Developing a unique kidney donor risk index model in Japan.

Abstract

Background: In the United States, the Kidney Donor Risk Index (KDRI) is utilized to evaluate the suitability of deceased donor kidneys. Since the data analyzed to derive the KDRI is based on the donor characteristics and recipient outcome of the experience in the US, caution is needed when utilized in non-US settings. In Japan, although having unique donor and allocation characteristics, development of an original index model based on native data has not been previously studied. Our final goal is to develop an original index model for the evaluation of the suitability of deceased donor kidneys in Japan based on the donor and recipient data. Methods: In this study we preliminarily reviewed the univariate analyses of multiple graft survival rate factors published by the Japan Organ Transplant Network (JOT) in the Organ Donation and Transplantation Databook 2017 (ODTD 2017) to explore the possibility of developing an original index model for the evaluation of the suitability of deceased donor kidneys. Results: The data analyzed in the ODTD 2017 includes every organ donation (423 donations after brain death (DBD) and 1,589 donations after circulatory death (DCD)) and kidney transplant (N=3,679) in Japan since April 1995 through 2016. The analyzed data included 56 factors which 38 were donor or allocation related. Of the 38 factors, type of donation (DBD vs DCD), donor age, cause of death (cerebrovascular disease vs others), final serum creatinine, HCV antibody, diabetes mellitus (HbA1c), pre-circulatory-death catheterization in DCD, HLA mismatch, duration from onset to recovery, warm ischemic time, and total ischemic time had a significant difference in graft survival rates. Conclusions: Of the 11 donor and allocation factors that graft survival rates were significantly different, 7 factors are explicit before recovery, therefore suggesting the possibility of utilizing these factors in the development of an original index model for the evaluation of the suitability of deceased donor kidneys in Japan. For further development of an index model, a multivariate analysis must be performed including these donor factors, as well as others that were not included (such as estimated glomerular filtration rate). This study was supported by the Japan Agency for Medical Research and Development (AMED) under grant number JP18ek0310011.