The Impact of Kidney Donor Risk Index On Graft Outcomes in Korean Population.

Abstract

Background: The expanded criteria donor(ECD) and non-ECD dichotomy has been used for evaluating organ quality and for making dicision about accepting organ offers and conunseling patients about risk. United network for organ sharing developed continuous kidney donor risk index (KDRI) to measure the spectrum of risk associated with the various factors known to influence graft failure. This study was performed to validate KDRI in assessing deceased donor kidney of Korean population. Methods: We retrospectively studied 404 patients who undertook kidney transplant from 5 transplantation centers of 2,3 territory from 2000 to 2010. Distribution of KDRI of donor kidney was calcuated and distribution of kidney donors by ECD/non-ECD and KDRI was compared. KDRI were divided into 5 groups; less than 0.8, 0.8-1.0, 1.0-1.2, 1.2-1.4, and more than 1.4. One-year graft function and five-year graft survival among KDRI goups were analysed. Results: Mean age was 42.9 (SD 10.9) years and male were 221 (54.7%). Mean follow-up duration was 52.7 (range 12-148) months. Mean KDRI was 1.01 (range 0.55-1.88). More than 90% of donor had KDRI less than 1.4. The distribution of kidneys by KDRI groups were 22.8%, 32.7%, 27.5%, 9.9% and 7.2% respectively. Among kidneys with KDRI less than 0.8, 10.5% were ECD, whereas all of the kidneys with KDRI more than 1.4 were ECD. One-year graft function by KDRI groups were 72.2, 65.8, 63.2, 69.1, and 47.1 mg/dL respectively, graft function was significantly low in KDRI >1.4 (P<0.001). Five-year graft survival by KDRI groups were 91.6%, 92.2%, 91.3%, 94.1% and 56.4%, graft survival was significantly low in KDRI more than 1.4 (P=0.001). Conclusion: The KDRI is a useful tool to estimate of posttransplant outcome in Korean population. The KDRI can be used as an additional assessment tool to physicians to assist them in making dicision about donor organ selection.