Kidney Donor Profile Index Score Research Articles

Expanding Access to High KDPI Kidney Transplant for Recipients Aged 60 y and Older: Cost Utility and Survival.

Modern organ allocation systems are tasked with equitably maximizing the utility of transplanted organs. Increasing the use of deceased donor organs at risk of discard may be a cost-effective strategy to improve overall transplant benefit. We determined the survival implications and cost utility of increasing the use of marginal kidneys in an older adult Canadian population of patients with end-stage kidney disease. We constructed a cost-utility model with microsimulation from the perspective of the Canadian single-payer health system for incident transplant waitlisted patients aged 60 y and older. A kidney donor profile index score of ≥86 was considered a marginal kidney. Donor- and recipient-level characteristics encompassed in the kidney donor profile index and estimated posttransplant survival scores were used to derive survival posttransplant. Patients were followed up for 10 y from the date of waitlist initiation. Our analysis compared the routine use of marginal kidneys (marginal kidney scenario) with the current practice of limited use (status quo scenario). The 10-y mean cost and quality-adjusted life-years per patient in the marginal kidney scenario were estimated at $379 485.33 (SD: $156 872.49) and 4.77 (SD: 1.87). In the status quo scenario, the mean cost and quality-adjusted life-years per patient were $402 937.68 (SD: $168 508.85) and 4.37 (SD: 1.87); thus, the intervention was considered dominant. At 10 y, 62.8% and 57.0% of the respective cohorts in the marginal kidney and status quo scenarios remained alive. Increasing the use of marginal kidneys in patients with end-stage kidney disease aged 60 y and older may offer cost savings, improved quality of life, and greater patient survival in comparison with usual care.

Validation of the kidney donor profile index (KDPI) for deceased donor kidney transplants in China

BackgroundThe kidney donor profile index (KDPI) evaluates kidney donor's age, height, weight, ethnicity, cause of death, high blood pressure, diabetes, exposure to hepatitis C and estimated glomerular filtration (eGFR). Kidneys with lower KDPI scores are expected to function longer that those with higher KPDI values. The applicability of KDPI score in Chinese kidney transplant donation has not yet been validated. This study evaluated the prognostic value of KDPI score in Chinese kidney transplant patients. MethodsA retrospective analysis was conducted on 184 deceased donors and 353 corresponding kidney transplant patients at the Organ Transplantation Department of Renmin Hospital of Wuhan University between 2018 and 2021. The donors and recipients were stratified into four groups based on their KDPI score: KDPI 85–100, KDPI 60–84, KDPI 21–59, and KDPI 0–20. ResultsAs expected, the KDPI 85–100 group was associated with a poor short-term renal function (both postoperative creatinine and eGFR with P > 0.05), a higher incidence of delayed graft function (DGF; 25.5% for KDPI 85–100 group vs. 10.2% for KDPI 60–84 group vs. 5.4% for KDPI 21–59 group vs. 0 for KDPI 0–20 group, all P > 0.05). Furthermore, the same groups showed worse 3-year patient survival rate: 86.3% for KDPI 85–100 group vs. 97.01% for KDPI 60–84 group vs. 97.83% for KDPI 21–59 group vs. 100% for KDPI 0–20 group, all P > 0.05); and renal survival rate: 82.6% for KDPI 85–100 group vs. 92.99% KDPI 60–84 group vs.97.83% for KDPI 21–59 group vs. 100% for KDPI 0–20 group, all P > 0.05). Our analysis showed that the KDPI score had a good predictive value for the survival of kidney transplants and patients in our center (area under the curve: 0.728 and 0.76, P > 0.05). ConclusionWe recommend that the KDPI scoring system can be employed as an effective tool to predict kidney transplantation outcomes in deceased donation in China.

The Effect of Perfusate Temperature on Delayed Graft Function in Deceased Donor Renal Transplantation.

Introduction: Renal allograft hypothermic machine perfusion results in a decreased incidence of delayed graft function compared with static cold storage. Ensuring perfusate temperatures remain within the target range of 4-10 °C may impact delayed graft function rates. Project Aims: To identify whether this target was achieved and, if not, whether higher perfusate temperature was associated with delayed graft function. Design: In this retrospective cohort study, transplanted grafts from deceased donors placed on hypothermic machine perfusion pump from June 2019 to August 2020 were analyzed. Measurements were recovered after 5, 15, 60, and 180 min of perfusion. Univariable and multivariable analyses were performed to identify predictors of delayed graft function. Results: A total of 113 grafts from 94 donors were analyzed. Of these, 21 (19%) developed delayed graft function. On univariable logistic regression, variables associated with delayed graft function included older donor age (OR 1.08, P = .002), higher Kidney Donor Profile Index score (OR 1.03, P = .024), and higher 5-min perfusate temperature (T5 min; OR 1.49, P = .014). A higher T5 min was also associated with delayed graft function in multivariable logistic regression models (OR 1.58, P = .005; OR 1.37, P = .08). Grafts with T5 min >10 °C were more likely to experience delayed graft function than those with T5 min <10 °C (OR 4.5, P = .006). Conclusion: Higher early perfusate temperature was an independent predictor of delayed graft function and may be due to inadequate cooling of the circuit prior to placing grafts on pump. Quality improvement initiatives targeting early perfusate temperatures of ≤10 °C may reduce delayed graft function incidence.

RWD105 To What Extent Is Allocation of Higher KDPI Score Kidney Transplantation Occurring in the US?

To better serve patients on the kidney transplant waitlist in the US, current guidance recommends the expanded use of kidneys with higher Kidney Donor Profile Index (KDPI) score to offset the limited supply of standard criteria donor. This research aims to explore KDPI score and evaluate patient characteristics associated with higher KDPI Kidney Transplant (KT).

Fate of discarded kidney transplants: experience of the transplant university hospital center of Rennes

In a context of tension on the number of available kidney transplants compared to the number needed, the practices of refusal of transplants in the Rennes transplantation center were evaluated. The donors completely refused by our team (no kidney accepted for any Rennes recipient) between January 1st2012 and December 31st2015 were identified from the national CRISTAL registry. The outcome of these refused transplants (possible transplantation in another center), the data of the recipients (from Rennes and other centers) and the data of the donors (refused and then finally accepted) were extracted. The outcome of recipients (from Rennes and other centers) was compared: graft survival (censored on death) and patient survival (not censored on cessation of function). The Kidney Donor Profile Index (KDPI) score was calculated and its usefulness studied. Among the 203 rejected donors, 172 (85%) were accepted for transplantation in another center; 89% of these grafts were functional at one year. In univariate analysis, Rennes recipients transplanted after a refusal had a better graft survival (censored on death) than recipients transplanted in another center with the refused graft (p < 0.001). The main limitation of this analysis is the non-comparability of the groups. The KDPI score was significantly associated with graft survival (censored on death). Of the 151 Rennes patients who had a refusal, 3% were still on the waiting list at the end of the observation period, the others spent a median additional time on dialysis of 220 days (Q1-Q3 81-483). Rennes recipients transplanted after a first refusal seem to have a better graft survival (censored on death) than recipients from other centers transplanted with refused grafts. This is to be weighed against the additional time on dialysis and even the risk of non-transplantation.

RWD69 5-Year Graft Failure Outcomes Utilizing Kidneys with Higher Kidney Donor Profile Index Scores across Different Age Groups and Sex over a 10-Year Period

Several studies have shown that kidney transplantations with higher kidney donor profile index (KDPI) scores reduced mortality rates compared with remaining on dialysis or the waitlist hoping to receive a lower KDPI kidney. This study described the rate of 5-year graft failure of higher KDPI kidney transplants between sex and across different age groups.

Distinct phenotypes of kidney transplant recipients aged 80 years or older in the USA by machine learning consensus clustering

ObjectivesThis study aimed to identify distinct clusters of very elderly kidney transplant recipients aged ≥80 and assess clinical outcomes among these unique clusters.DesignCohort study with machine learning (ML) consensus clustering...

The results after induction of rabbit anti-thymocyte globulin in the deceased donor kidney transplantation using the grafts of above kidney donor profile index score &gt;65%

The results after induction of rabbit anti-thymocyte globulin in the deceased donor kidney transplantation using the grafts of above kidney donor profile index score &gt;65%

Kidney Donor Profile Index and allograft outcomes: interactive effects of estimated post-transplant survival score and ischaemic time.

The Kidney Donor Profile Index (KDPI) is routinely reported by the donation agencies in Australia. We determined the association between KDPI and short-term allograft loss and assessed if this association was modified by the estimated post-transplant survival (EPTS) score and total ischaemic time. Using data from the Australia and New Zealand Dialysis and Transplant Registry, the association between KDPI (in quartiles) and 3-year overall allograft loss was examined using adjusted Cox regression analysis. The interactive effects between KDPI, EPTS score and total ischaemic time on allograft loss were assessed. Of 4006 deceased donor kidney transplant recipients transplanted between 2010 and 2015, 451 (11%) recipients experienced allograft loss within 3years post-transplant. Compared with recipients of kidneys with a KDPI of 0-25%, recipients who received donor kidneys with a KDPI >75% experienced a 2-fold increased risk of 3-year allograft loss {adjusted hazard ratio [HR] 2.04 [95% confidence interval (CI) 1.53-2.71]}. The adjusted HRs for kidneys with a KDPI of 26-50% and 51-75% were 1.27 (95% CI 0.94-1.71) and 1.31 (95% CI 0.96-1.77), respectively. There were significant interactions between KDPI and EPTS scores (P-value for interaction <.01) and total ischaemic time (P-value for interaction <.01) such that the associations between higher KDPI quartiles and 3-year allograft loss were strongest in recipients with the lowest EPTS scores and longest total ischaemic time. Recipients with higher post-transplant expected survival and transplants with longer total ischaemia who received donor allografts with higher KDPI scores experienced a greater risk of short-term allograft loss compared with those recipients with reduced post-transplant expected survival and with shorter total ischemia.

Transplant or dialysis: What's the better choice for RCC-induced ESRD patients? A 20-year analysis of OPTN/UNOS data.

PurposeThe incidence of end-stage renal disease (ESRD) caused by renal cell carcinoma (RCC) is increasing with the high prevalence of RCC as well as those with treatment-related renal function impairment. Worries about tumor recurrence after transplant-related immunosuppression hinder the recommendation of kidney transplantation for RCC-induced ESRD patients. However, no direct analysis has been performed to identify whether kidney transplantation can offer better survival than maintaining dialysis.Materials and methodsThis retrospective population-based cohort study was based on Organ Procurement and Transplantation Network data released in March 2021. Characteristics and outcomes were compared, including the patient and graft survival of candidates and recipients with RCC-induced ESRD etiology as well as other primary diseases.ResultsPatients with RCC-induced ESRD were older; more likely to be male, White, and obese; and more likely to have a history of diabetes and dialysis. They also had higher creatinine levels, more delayed graft function, more primary non-function, and higher Kidney Donor Profile Index score donors, compared with the glomerulonephritis (GN) group. While waiting, RCC candidates suffered the worst outcomes of all groups, a 44% (adjusted hazard ratio [aHR], 1.44 [1.27–1.62]) higher risk of removal than GN patients. After transplantation, RCC recipients demonstrated comparable patient survival and better graft survival (p=0.21 and p=0.13, respectively). Compared with still-waiting RCC patients, the RCC recipients who received kidney transplants had significantly better outcomes (13.6 [9.3–17.8] vs. 61 [52–68.4] %), decreasing the death or deteriorating risk by 84% (aHR, 0.16 [0.13–0.20]).ConclusionsPatients with RCC-induced ESRD can dramatically benefit from kidney transplantation. Hence, these patients should not be limited to transplantation by strict strategies or a delayed waiting time out of their malignancy history.

Graft survival after kidney transplantation with standard versus prolonged kidney procurement time

Background:During kidney procurement, after ice removal, kidneys located in the retroperitoneum are at risk for rewarming owing to the time taken to retrieve other abdominal and thoracic organs, which may lead to poorer outcomes. The purpose of this study was to evaluate the impact of prolonged kidney procurement time (PKP) on outcomes of kidney transplantation performed at the Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada.Methods:We retrospectively reviewed the cases of all adult (age ≥ 18 yr) patients who underwent kidney transplantation at the Queen Elizabeth II Health Sciences Centre between Jan. 1, 2010, and Dec. 31, 2015. We included all patients who received kidney transplants from deceased donors with a minimum follow-up period of 3 years. We defined PKP as more than 65 minutes from aortic cross-clamp to final organ extraction, and standard procurement time (SP) as 65 minutes or less.Results:Among the 455 transplantation procedures performed during the study period, we reviewed the cases of 145 patients who received kidneys from Nova Scotian donors and were followed in Nova Scotia. No statistically significant differences were seen in outcomes between kidney-only (n = 46) and multiorgan (n = 99) procurement, although more organs from kidney-only donors than multiorgan donors had a Kidney Donor Profile Index score greater than 50% (32 [69.6%] v. 48 [48.5%], p < 0.01). Compared to the SP group (n = 115), the PKP group (n = 30) had a higher rate of 30-day graft loss (6.7% v. 0.0%, p < 0.01), a higher incidence of de novo formation of donor-specific antibodies (3 [10.0%] v. 1 [0.9%], p < 0.01) and a lower 5-year graft survival rate (90.0% v. 97.4%, p = 0.03). Left kidneys remained 11 minutes longer on the donor than right kidneys when multiorgan procurement was performed (p < 0.01), and their 5-year survival rate was significantly lower than that of right kidneys (p = 0.03).Conclusion:Procurement times longer than 65 minutes may be associated with poorer outcomes after kidney transplantation. Measures to reduce kidney exposure to rewarming during procurement may improve long-term outcomes.

Multi-photon microscopy for the evaluation of interstitial fibrosis in extended criteria donor kidneys: A proof-of-concept study.

To evaluate the initial use of label-free second harmonic generation (SHG) imaging with two-photon excitation (2PE) auto-fluorescence in multiphoton microscopy (MPM) for the quantification of collagen/fibrosis on preimplantation biopsies of extended criteria donors (ECD). Twenty preimplantation core biopsies were extracted from 10 donor kidney samples, of which originated from seven donors. Kidney Donor Profile Index (KDPI) and Remuzzi scores of biopsies were calculated. Collagen parameters measured included quantification by the Collagen Area Ratio in Total Tissue (CART) and qualitative measurements by Collagen Reticulation Index (CRI). Biopsies classified with>85% KDPI scores had significantly higher CART (p=.011) and lower CRI values (p=.025) than biopsies with ≤ 85% KDPI scores. Increase in CRI values correlated significantly with rise in recipient creatinine levels 1-year post-transplant (p=.027; 95% CI: 4.635-66.797). MPM is an evolving technology that enables the quantification of the amount (CART) and quality (CRI) of collagen deposition in unstained preimplantation biopsies of donor kidneys stratified by KDPI scores. This initial evaluation found significant differences in both parameters between donor kidneys with more or less than 85% KDPI.

Use of Machine Learning Consensus Clustering to Identify Distinct Subtypes of Black Kidney Transplant Recipients and Associated Outcomes

Among kidney transplant recipients, Black patients continue to have worse graft function and reduced patient and graft survival. Better understanding of different phenotypes and subgroups of Black kidney transplant recipients may help the transplant community to identify individualized strategies to improve outcomes among these vulnerable groups. To cluster Black kidney transplant recipients in the US using an unsupervised machine learning approach. This cohort study performed consensus cluster analysis based on recipient-, donor-, and transplant-related characteristics in Black kidney transplant recipients in the US from January 1, 2015, to December 31, 2019, in the Organ Procurement and Transplantation Network/United Network for Organ Sharing database. Each cluster's key characteristics were identified using the standardized mean difference, and subsequently the posttransplant outcomes were compared among the clusters. Data were analyzed from June 9 to July 17, 2021. Machine learning consensus clustering approach. Death-censored graft failure, patient death within 3 years after kidney transplant, and allograft rejection within 1 year after kidney transplant. Consensus cluster analysis was performed for 22 687 Black kidney transplant recipients (mean [SD] age, 51.4 [12.6] years; 13 635 men [60%]), and 4 distinct clusters that best represented their clinical characteristics were identified. Cluster 1 was characterized by highly sensitized recipients of deceased donor kidney retransplants; cluster 2, by recipients of living donor kidney transplants with no or short prior dialysis; cluster 3, by young recipients with hypertension and without diabetes who received young deceased donor transplants with low kidney donor profile index scores; and cluster 4, by older recipients with diabetes who received kidneys from older donors with high kidney donor profile index scores and extended criteria donors. Cluster 2 had the most favorable outcomes in terms of death-censored graft failure, patient death, and allograft rejection. Compared with cluster 2, all other clusters had a higher risk of death-censored graft failure and death. Higher risk for rejection was found in clusters 1 and 3, but not cluster 4. In this cohort study using an unsupervised machine learning approach, the identification of clinically distinct clusters among Black kidney transplant recipients underscores the need for individualized care strategies to improve outcomes among vulnerable patient groups.

Abnormal time-zero histology is predictive of kidney transplant outcomes.

Time-zero biopsies can detect donor-derived lesions at the time of kidney transplantation, but their utility in predicting long-term outcomes is unclear under the updated Kidney Allocation System. We conducted a single-center retrospective cohort study of 272 consecutive post-reperfusion time-zero biopsies. We tested the hypothesis that abnormal time-zero histology is a strong indicator of donor quality that increases the precision of the kidney donor profile index (KDPI) score to predict long-term outcomes. We detected abnormal biopsies in 42% of the cohort, which were independently associated with a 1.2-fold increased hazard for a composite of acute rejection, allograft failure, and death after adjusting for clinical characteristics including KDPI. By Kaplan-Meier analysis, the relationship between abnormal time-zero histology and the composite endpoint was only significant in the subgroup of deceased donor kidney transplants with KDPI scores >35. Abnormal time-zero histology, particularly vascular intimal fibrosis and arteriolar hyalinosis scores, was independently associated with lower 12-month estimated GFR. In conclusion, abnormal time-zero histology is relatively common and identifies a group of kidney recipients at increased risk for worse long-term outcomes. Further studies are needed to determine the optimal patient population in which to deploy time-zero biopsies as an additional surveillance tool.

A Simple Incentive Mechanism to Alleviate the Burden of Organ Wastage in Transplantation

Despite efforts to increase the supply of donated organs for transplantation, organ shortages persist. We study the problem of organ wastage in a queueing-theoretic framework. We establish that self-interested individuals set their utilization levels more conservatively in equilibrium than the socially efficient level. To reduce the resulting gap, we offer an incentive mechanism that recompenses candidates returning to the waitlist for retransplantation, who have accepted a predefined set of organs, for giving up their position in the waitlist and show that it increases the equilibrium utilization of organs while also improving social welfare. Furthermore, the degree of improvement increases monotonically with the level of this nonmonetary compensation provided by the mechanism. In practice, this mechanism can be implemented by preserving some fraction of the waiting time previously accumulated by returning candidates. A detailed numerical study for the U.S. renal transplant system suggests that such an incentive helps significantly reduce the kidney discard rate (baseline: 17.4%). Depending on the strength of the population’s response to the mechanism, the discard rate can be as low as 6.2% (strong response), 12.4% (moderate response), or 15.1% (weak response), which translates to 1,630, 724, or 338 more transplants per year, respectively. Although the average quality of transplanted kidneys deteriorates slightly, the resulting graft survival one-year posttransplant remains stable around 94.8% versus 95.0% for the baseline. We find that the optimal Kidney Donor Profile Index score cutoff, defining the set of incentivized kidneys, is around 85%, which coincides with the generally accepted definition of marginal kidneys in the medical community. This paper was accepted by David Simchi-Levi, stochastic models and simulation.

Impact of acute kidney injury in deceased donors with high Kidney Donor Profile Index on posttransplant clinical outcomes: a multicenter cohort study.

BackgroundThis study evaluated the impact of acute kidney injury (AKI) on posttransplant clinical outcomes for deceased donor (DD) kidney transplantation (KT) using the Kidney Donor Profile Index (KDPI) system.MethodsOverall, 657 kidney transplant recipients (KTRs) receiving kidneys from 526 DDs from four transplant centers were included. We divided them into the high and low KDPI donor groups by 65%, the KDPI score, and both groups were subdivided into the AKI-DDKT and non-AKI-DDKT subgroups according to AKI in DDs.ResultsThere was no significant difference in the incidence of delayed graft function (DGF) between the high and low KDPI-KTR groups; however, the AKI-DDKT subgroup showed significantly higher incidence of DGF than the non-AKI-DDKT subgroup in both groups (p = 0.001, p < 0.001, respectively). The death-censored graft survival rate was significantly lower in the high KDPI-KTR group than in the low KDPI-KTR group (p = 0.005). Only in the high KDPI-KTR group, the death-censored graft survival rate was significantly lower in the KT from DDs with AKI stage 3 than KT from DDs with non-AKI or AKI stage 1 or 2 (p = 0.040). The interaction between AKI stage 3 in DDs and high KDPI on the allograft outcome was significant (p = 0.002).ConclusionKTs from DDs with AKI stage 3 showed an adverse impact on the allograft outcome in the high KDPI-KTR group. Therefore, DDs with a high KDPI score should be managed carefully so that severe AKI does not occur prior to KT.

Are Kidney Donor Risk Index/Kidney Donor Profile Index Scores Predictor of Future Graft Function?

Kidney donor profile index (KDPI) is a method developed to assess donor kidney quality for cadaveric transplants. We investigated the relationship between kidney donor risk index (KDRI) and KDPI scores of cadaveric transplants in the last five years in our clinic and current graft conditions. Forty people (12 females, 28 males; mean age, 46.35 + 8.94 years), who underwent cadaveric transplantation between January 2013 and March 2018, were participated in this study. At the same time, the KPDI and KDRI scores of the donor's kidneys were calculated and then compared with that of the recipients' data. The mean KDRI value of donors was 1.11 ± 0.33 and the median KDPI value was 60.50%. KDRI/KDPI scores were found to be high in women (P = 0.021) and, when the posttransplant findings of the recipients were evaluated by bivariate correlation analysis KDRI/KDPI scores were positively correlated with the day when creatinine (Cr) values started to fall off spontaneously (r = 0.457, P = 0.003). It was observed that recipients who were transplanted from the donors with high KDRI/KDPI scores had higher Cr levels (P <0.01) and this relationship did not change over time (P = 0.115). When the donors were grouped as the standard-criteria donor and expanded-criteria donor (ECD); we found that the relationship between KDRI/KDPI, creatinine, and time was more significant in the ECD group (P = 0.04). KDRI/KDPI scores are closely related to graft outcomes especially in recipients that have kidneys from marginal donors. Therefore, evaluation of KDRI/KDPI scores might be required in marginal donors.

Donor-Recipient Matching to Optimize the Utility of High Kidney Donor Profile Index Kidneys

BackgroundIn December 2014, the Kidney Donor Profile Index (KDPI) was developed to give more precise information on donor kidney quality. Kidneys with KDPI scores ≥ 85 (K ≥ 85) have been reported to have inferior outcomes to kidneys with KDPI scores < 85. MethodsAfter the implementation of the new Kidney Allocation System, we developed a protocol to evaluate K ≥ 85 use. We analyzed the safety and efficacy of our institutional criteria and evaluated post-transplant outcomes. K ≥ 85 recipients were stratified based on their 1-year creatinine and estimated glomerular filtration rates to elucidate characteristics associated with serum creatinine < 1.7 mg/dL or estimated glomerular filtration rates ≤ 45 mL/min/1.73 m2. ResultsFrom December 2014 to December 2019, 304 deceased donor kidney transplants were performed at Hartford Hospital; 58 (19%) were K ≥ 85 with an average KDPI of 91%. There were 4 graft losses; 2 were death censored. Prolonged cold ischemia time and black recipient race were associated with inferior recipient graft function at 1 year. ConclusionsHigh KDPI kidney use requires a multifaceted evaluation that takes into account donor and recipient characteristics for an ideal match. We have identified several characteristics that may predict optimal post-transplant kidney function.

CON: Liver Transplant Alone.

CON: Liver Transplant Alone.

Impact of donor factors on post-transplant delayed recovery of graft function in deceased donor kidney transplantation

Background: Deceased donor (DD) factors influence absolutely the post-transplant delayed recovery of graft function (DGF) in deceased donor kidney transplantation (DDKT). Although there are some tools for the status of DD such as expanded criteria donor criteria or kidney donor profile index score, but these tools do not fully reflect impact of DD factors on post-transplant DGF. Therefore, we aimed at investigating the DD factors related with the occurrence of DGF in DDKT. Methods: We retrospectively analyzed the medical records of DDKT performed at Keimyung University Dongsan Medical Center between February 2014 and September 2019. Our study enrolled 186 kidney transplant recipients (KTRs), with median follow-up of 45 months after DDKT. Results: Eighty-seven DDs (46.5%) had a documented history of smoking; 108 (57.8%), proteinuria; 80 (42.8%), transfusion; 95 (50.8%), acute kidney injury (AKI); and continuous renal replacement therapy (CRRT), 18 (9.6%). The incidence of DGF was sig nificantly higher in KTRs from DDs with CRRT compared to those from DDs without CRRT (P=0.002). The incidence of DGF was also higher in KTRs from DDs with smoking history, but there were no significant association with the presence and amount of proteinuria and transfusion. Allograft function was significantly lower in the KTRs with DGF until 1 month after KT compared to those without DGF, but there was no significant difference of allograft function between the two groups at 12 months after KT. In Kaplan-Meier analysis, graft and patient survivals did not show the differences according to the characteristics of DDs with smoking, proteinuria, transfusion, AKI, and CRRT. In multivariate logistic analysis, AKI, CRRT, smoking, and donor hypertension were independent risk factors for DGF. Conclusions: DDs with AKI, CRRT, smoking, and hypertension can increase the risk of occurrence of DGF in KTRs. Therefore, DDKT from DDs with significant risk factors should be performed carefully.