Clinical significance of the Kidney Donor Profile Index in deceased donors for prediction of post-transplant clinical outcomes: A multicenter cohort study.

Jong Hoon Lee,Byung Ha Chung,Woo Yeong Park,Yong-Soo Kim,Seungyeup Han,Bum Soon Choi,Cheol Whee Park,Kyubok Jin,Chul Woo Yang,Young Soo Kim,Gianpaolo Reboldi

doi:10.1371/journal.pone.0205011

Jong Hoon Lee, Byung Ha Chung + Show 9 more

Open Access

https://doi.org/10.1371/journal.pone.0205011

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Abstract

BackgroundWe investigated whether the Kidney Donor Profile Index (KDPI) system is useful in predicting clinical outcomes in deceased donor kidney transplantation (DDKT).MethodsFour hundred sixty-nine kidney transplant recipients (KTRs) receiving kidneys from 359 deceased donors were included in this study, which involved three transplant centers. KTRs were divided into high and low KDPI KTR groups based on the median KDPI score of 67%. We compared clinical outcomes between the high KDPI and low KDPI groups.ResultsThere were no significant differences in the incidence of delayed graft function and acute rejection between high and low KDPI KTR groups. In comparison with histologic findings in allograft tissues obtained within three months from KT, the proportion of glomerulosclerosis was significantly higher in the high KDPI KTR group than in the low KDPI KTR group. With Kaplan-Meier analysis, the graft survival rate was significantly lower in the high KDPI KTR group than in the low KDPI KTR group (Log rank, P = 0.017), and multivariate analysis also demonstrated that a high KDPI score was a significant risk factor for death censored allograft failure (HR 2.62, 95% CI, 1.29–5.33, P = 0.008).ConclusionThe KDPI scoring system is useful in predicting allograft outcomes in a Korean DDKT cohort.

Highlights

As the number of end stage renal disease (ESRD) patients increases, so does the demand for kidney donation [1]
There were no significant differences in the incidence of delayed graft function and acute rejection between high and low Kidney Donor Profile Index (KDPI) kidney transplant recipients (KTRs) groups
In comparison with histologic findings in allograft tissues obtained within three months from kidney transplantation (KT), the proportion of glomerulosclerosis was significantly higher in the high KDPI KTR group than in the low KDPI KTR group

Summary

Introduction

As the number of end stage renal disease (ESRD) patients increases, so does the demand for kidney donation [1]. A severe donor shortage results in the gradual prolongation of the waiting time for deceased donor kidney transplantation (DDKT) [2,3,4,5]. The use of kidneys from marginal donors, such as the elderly or those with renal impairment or underlying chronic kidney disease, has been proposed as an important strategy for solving this donor shortage [6,7,8,9]. The most widely used criteria for the definition of marginal donors has been the expanded criteria donor (ECD) according to the United Network for Organ Sharing (UNOS) [10]. We investigated whether the Kidney Donor Profile Index (KDPI) system is useful in predicting clinical outcomes in deceased donor kidney transplantation (DDKT)

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Results

Conclusion