Kidney Donor Risk Index Score Research Articles

Impact of Donor Warm Ischemia Time on Graft Survival for Donation After Circulatory Death Kidney Transplantation.

The utilization of kidneys donated after circulatory death (DCD) is an important strategy to address the ongoing shortage of organs suitable for transplantation in the United States. However, the nonuse rate of DCD kidneys remains high compared with kidneys donated after brain death (DBD) because of concerns regarding the injury incurred during donor warm ischemia time (DWIT). Therefore, we investigated the impact of DWIT on the risk of death-censored graft failure after DCD kidney transplantation (KT). Retrospective analysis was conducted on DCD KTs using the Standard Transplant Analysis and Research data set. The association of DWIT with death-censored graft failure was evaluated using multivariable Cox proportional hazard regression, with reference to DCD KTs with Kidney Donor Risk Index (KDRI) of ≤0.78 and the median DWIT of 26 min. A total of 28 032 DCD kidney-alone transplants between January 2010 and December 2021 were studied. When stratified by KDRI, increasing DWIT was associated with a clinically significant increased risk for death-censored graft failure only in the subset of kidneys with KDRI >1.14 but not in those with KDRI >0.78-≤0.94 and >0.94-≤1.14, compared with the reference group. We suggest that clinicians should not decline kidneys on the basis of DWIT in favor of potential offers of DBD or other DCD kidneys with shorter DWIT, provided that their KDRI scores are within an acceptable limit. Our study highlights opportunities for more efficient usage of DCD kidneys and improving the shortage of transplantable organs.

Multiview Clustering to Identify Novel Kidney Donor Phenotypes for Assessing Graft Survival in Older Transplant Recipients.

Older transplant recipients are at a relatively increased risk of graft failure following transplantation and some of this risk may relate to donor characteristics. Unsupervised clustering using machine learning may be a novel approach to identify donor phenotypes that may then be used to evaluate outcomes for older recipients. Using a cohort of older recipients, the purpose of this study was to A) use unsupervised clustering to identify donor phenotypes and B) determine the risk of death/graft failure for recipients of each donor phenotype. We analyzed a nationally representative cohort of kidney transplant recipients age >65 years captured using the Scientific Registry of Transplant Recipients between 2000-2017. Unsupervised clustering was used to generate phenotypes using donor characteristics inclusive of variables in the kidney donor risk index (KDRI). Cluster assignment was internally validated. Outcomes included all-cause graft failure (including mortality) and delayed graft function (DGF). Differences in the distribution of KDRI scores were also compared across the clusters. All-cause graft failure was compared for recipients of donor kidneys from each cluster using a multivariable Cox-Survival analysis. Overall, 23,558 donors were separated into five clusters. The area under the curve for internal validation of cluster assignment was 0.89. Recipients of donor kidneys from two clusters were found to be at high risk of all-cause graft failure relative to the lowest risk cluster (adjusted hazards ratio 1.86, 95% CI 1.69-2.05 and 1.73, 95% CI 1.61-1.87). Only, one of these high-risk clusters had high proportions of donors with established risk factors (i.e., hypertension, diabetes). KDRI scores were similar for the highest and lowest risk clusters (1.40 [1.18-1.67] and 1.37 [1.15-1.65], respectively). Unsupervised clustering can identify novel donor phenotypes comprised of established donor characteristics that, in turn, may be associated with different risks of graft loss for older transplant recipients.

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.

P1688THE IMPACT OF KIDNEY DONOR PROFILE INDEX (KDPI) AND KIDNEY DONOR RISK INDEX (KDRI) ON KIDNEY TRANSPLANT FUNCTION: A MONOCENTRIC ANALYSIS AFTER ONE YEAR OF FOLLOW UP

Abstract Background and Aims Evaluation of kidney donors is a complex process based on the elaboration of clinical, laboratory and imaging data. Until 2014, the quality of kidney transplant (KTx) was assessed considering standard donation criteria (SCD) or extended donation criteria (ECD). ECD kidneys (kECD) defined subjects older than 65 years without comorbidities or younger, but with comorbidities, such as hypertension, cerebral stroke, high creatinine level (above 1.5 mg/dL). The Kidney Donor Risk Index (KDRI) is an estimate of the relative risk of post-transplant kidney graft failure from a particular deceased donor compared to a reference donor. The value obtained is than converted in a percentage called KDPI (KDPI ≥85% is considered as similar of a kidney from ECD), which represent the percentage of utilized donor in the last year better than the considered. Italian experience in Donor Cardiac Death (DCD) is growing and doubled last KTx year, reaching 1.1 pmp in 2018, with the 22.5% of donors procured at our center. Our DCD KTx protocol has been active since November 2017, with promising results. We considered only controlled DCD (cDCD) Maastricht Class III. Methods We compared all DCD and DBD KTx performed in the Nephrology Unit of the University Hospital of Modena, Italy, from November 2017 to December 2018. We excluded living donor transplantation and combined liver–kidney transplantation. In this study, only cDCD are considered. We studied KDPI and KDRI score for both DBD and DCD KTx . Comparison between data from DCD and DBD was performed with t – Student and Chi Square test, survival analysis according to Kaplan-Meier and a Pearson correlation between KPI-KDRI and one year graft function was elaborated. ROC curve analysis was performed for KDPI – KDRI and DGF for both groups. A p lower than 0.05 was considered significant. Results A total of 28 DBD KTx, 18 double (64.3%) and 10 single (35.7%) and 7 DCD KTx, 3 double (42.8%) and 4 single (57.2%) were observed during the study. Donors and recipients clinical and immunological characteristics are reported in table1. All of DCD and 64.3% of DBD donors underwent kidney biopsy (Karpinski values are reported in table 1). Induction therapy was with aTG in DCD KTx and ECD DBD KTx and with anti-interleukin-2 receptor monoclonal antibodies in SCD DBD KTx. Maintenance immunosuppression consisted in steroid, tacrolimus and mycophenolic acid. KTx outcomes were reported in table 1 with no differences in both groups between creatinine (p0.3) and eGFR (p0.25). We analyzed KDPI and KDRI values from DBD and DCD KTx and we stratified them as reported in table 2. We found 7 DGF in DBD KTx (85% with KDPI &amp;gt;85% and KDRI &amp;gt;1.5) and only 1 DGF in DCD KTx with KDPI&amp;gt;85% and KDRI &amp;gt; 1.5. We did not find a statistical correlation between KDPI- KDRI and eGFR in both DBD KTx (2 patients died and 3 patients were lost at follow up) (r -0.32, p 0.13; r -0.26, p 0.22) and DCD KTx (r -0.59, p 0.15; r -0.47, p 0.28). (Figure 1) We performed a ROC curve Analysis to investigate the role of KDPI – KDRI and the risk of DGF. We found no statistical correlation in DCD KTx, considering the small sample size (p 0.61) but we found a significant statistical value in DBD KTx (p 0.03 – p 0.02 with a AUC of 0.77-0.78). Survival analysis did not show statistical difference between DBD and DCD (p 0.72), no graft loss in the first year, although two DBD (92.8%) recipients died (1circulatory arrest,1 sepsis), no one died in DCD group. Conclusion cDCD is a valid resource for KTx, with similar outcomes to DBD. This remarks the importance of a multidisciplinary team and a correct selection of donors. We did not find a correlation between KDPI-KDRI and KTX function after one year of follow up in our population for either group.

Kidney Donor Risk Index Score Is More Reliable Than Kidney Donor Profile Index in Kidney Transplantation From Elderly Deceased Donors

BackgroundIt is unclear whether both Kidney Donor Profile Index (KDPI) and Kidney Donor Risk Index (KDRI) scores can be applied to elderly deceased donors (DDs). This study aimed to compare the predictive values of KDRI and KDPI for the occurrence of delayed graft function (DGF) in kidney transplantation (KT) from elderly DDs. MethodsThe data for 1049 DD KTs from the database of the Korean Organ Transplant Registry were reviewed retrospectively. ResultsThe mean age of the 1049 DDs was 50.94 ± 10.57 years. A total of 224 DDs were ≥60 years old (21.35%). The mean KDRI and KDPI were 1.24 ± 0.40 and 63.58 ± 25.16, respectively. Ninety (8.6%) recipients had DGF postoperatively. The right-skewed distributions of KDRI in both elderly and nonelderly DDs were similar. However, the KDPI curve showed a sharp increase from a KDPI score of 60 in DDs aged ≥60 years. The areas under the curve (AUCs) of receiver operator characteristics (ROC) for KDPI and KDRI were different. In DDs aged <60 years, the estimated AUCs of ROC showed significant values for KDPI (0.577, 95% confidence interval, 0.503-0.637; P = .048) and KDRI (0.576, 0.505-0.639; P = .043). However, in DDs aged ≥60 years, KDRI score, not KDPI, was a significant value: KDRI, 0.633 (0.498-0.767; P = .034); KDPI, 0.530 (0.476-0.643; P = .138). ConclusionKDRI was more reliable in predicting graft outcome than KDPI in KT from elderly DDs. A longer follow-up period is needed to assess predictors for postoperative renal functions.

External validation of the US and UK kidney donor risk indices for deceased donor kidney transplant survival in the Australian and New Zealand population.

The US Kidney Donor Risk Index (KDRI) and the UK KDRI were developed to estimate the risk of graft failure following kidney transplantation. Neither score has been validated in the Australian and New Zealand (ANZ) population. Using data from the Australia and New Zealand Organ Donor (ANZOD) and Dialysis and Transplant (ANZDATA) Registries, we included all adult deceased donor kidney-only transplants performed in ANZ from 2005 to 2016 (n = 6405). The KDRI was calculated using both the US donor-only and UK formulae. Three Cox models were constructed (Model 1: KDRI only; Model 2: Model 1 + transplant characteristics; Model 3: Model 2 + recipient characteristics) and compared using Harrell's C-statistics for the outcomes of death-censored graft survival and overall graft survival. Both scores were strongly associated with death-censored and overall graft survival (P < 0.0001 in all models). In the KDRI-only models, discrimination of death-censored graft survival was moderately good with C-statistics of 0.63 and 0.59 for the US and UK scores, respectively. Adjusting for transplant characteristics resulted in marginal improvements of the US KDRI to 0.65 and the UK KDRI to 0.63. The addition of recipient characteristics again resulted in marginal improvements of the US KDRI to 0.70 and the UK KDRI to 0.68. Similar trends were seen for the discrimination of overall graft survival. The US and UK KDRI scores were moderately good at discriminating death-censored and overall graft survival in the ANZ population, with the US score performing slightly better in all models.

Organ donation after trauma: A 30-year review.

Over the past 30 years, the demographics, clinical characteristics, and management of trauma patients have changed dramatically. During this same period, the organ donor population has also changed. The interactions between these two demographic shifts have not been examined in a systematic way. We hypothesize that trauma victims continue to be an important source of organs. We set out to systematically examine traumatic donors in an attempt to identify opportunities to increase organ recovery and quality. In this retrospective analysis, we compared trauma donors (TDs) and non-TDs (NTDs) in the Scientific Registry of Transplant Recipients standard analysis files, a clinical data set collected by the Organ Procurement Transplant Network on all solid organ transplant candidates, donors, and recipients in the United States since 1987. Scientific Registry of Transplant Recipients contained data on 191,802 deceased donors. The percentage of TDs decreased from 55.3% in 1987 to 35.8% in 2016 (p < 0.001) primarily due to a steady increase in NTDs. Trauma donors are younger and have fewer comorbidities while the percentage of donors who were public health service high risk or who underwent donation after cardiac death were clinically similar. The TDs produce more organs/donor (3.5 vs. 2.4, p < 0.001), are more likely to yield an extrarenal organ, and exhibit lower (better) Kidney Donor Risk Index scores, a predictor of graft longevity. These better outcomes are maintained after stratifying by age. Over the past 30 years, the number of NTDs has increased much more than the number of TDs. However, TDs remain a critically important organ donor source, yielding more organs per donor, better quality kidneys, and a higher likelihood of extrarenal organs. Potential causes, such as improved resuscitation protocols, should be examined in the future. Retrospective review, level III.

Association of Kidney Donor Risk Index with the Outcome after Kidney Transplantation in the Eurotransplant Senior Program.

BackgroundWe evaluated the Kidney Donor Risk Index (KDRI) scoring system for kidney transplantation in the Eurotransplant Senior Program (ESP) that allocates kidneys from older donors to older recipients (≥65 years).Material/MethodsWe retrospectively analyzed data of 37 kidney transplant recipients and 36 kidney donors who participated in kidney transplantation program according to the ESP at our center from January 2004 until December 2013.ResultsMean recipient and donor age was 67.9±2.6 and 70.5±4.0 years respectively. The mean KDRI score was 1.7±0.27. Uncensored graft survival after 1 year and 5 years was 64.2% and 53.7% respectively. Subgroup analysis showed that in kidney transplantation with KDRI >1.83, graft survival was significantly reduced compared to lower KDRI subgroups. KDRI was significantly correlated with serum creatinine level at discharge (r=0.4).ConclusionsESP kidneys represent a group of high-risk grafts with high KDRI scores. Higher KDRI scores in ESP kidneys was associated with reduced postoperative short-term and long-term graft outcomes. KDRI might be useful in decision-making for selecting donors for ESP kidney transplantation.

Are we underestimating the quality of aviremic hepatitis C-positive kidneys? Time to reconsider.

Kidney Donor Risk Index (KDRI) introduced in 2009 included hepatitis C serologic but not viremic status of the donors. With nucleic acid amplification testing (NAT) now being mandatory, further evaluation of these donors is possible. We conducted a retrospective matched case-control analysis of adult deceased donor kidney transplants performed between December 5, 2014 to December 31, 2016 with the KDRI score and hepatitis C virus antibody (HCV Ab) and NAT testing status obtained from the United Network for Organ Sharing database. The 205 aviremic HCV Ab+ NAT - kidney transplants were compared to KDRI matched control kidneys that were HCV Ab-NAT-. The aviremic HCV kidneys were recovered from donors who were significantly younger, more likely to be white, and less likely to have hypertension and diabetes. The majority of the recipients of the aviremic HCV kidneys when compared to matched controls were HCV positive: 90.2% vs 4.3%. The recipients were significantly older, were on dialysis for a shorter time, and were transplanted sooner. The graft survival of aviremic HCV kidneys was similar (P<.08). If the HCV status of the aviremic kidneys was assumed to be negative, 122 more kidneys could have been allocated to patients with estimated posttransplant survival <20. Seven kidneys would no longer have Kidney Donor Profile Index >85%. Further policies might consider these findings to appropriately allocate these kidneys.

Validation of the Prognostic Kidney Donor Risk Index Scoring System of Deceased Donors for Renal Transplantation in the Netherlands.

The prognostic Kidney Donor Risk Index (KDRI)-developed and internally validated in the United States-is a widely used tool to predict transplant outcome of a deceased donor kidney. The KDRI is currently used for longevity matching between donors and recipients in the United States. We aimed to externally validate the KDRIdonor-only and KDRIfull as proposed by Rao et al (2009). KDRIdonor-only consist of 10 donor factors, and KDRIfull with an additional 4 transplant factors. We used the Dutch Organ Transplantation Registry to include 3201 adult recipients transplanted from 2002 to 2012. The median Dutch KDRI was 1.21 and comparable with the year 2012 in the United States (median of 1.24). The calibration-slope was 0.98 and 0.96 for the KDRIfull and KDRIdonor-only, respectively, indicating that predictions of graft failure were on average similar. The discriminative ability (Harrell C) of the KDRIfull and the KDRIdonor-only at 5 years was 0.63 (95% confidence interval [CI], 0.62-0.64), and 0.62 (95% CI, 0.61-0.63), respectively. We found misspecification of 3 KDRI factors: age (P = 0.002), weight (P = 0.017), and cold ischemia time (P < 0.001). Adding the use of inotropic drugs before donation (P = 0.040) and the interaction between circulatory-death donor kidneys and prolonged cold ischemic time (>24 hours vs 12 hours; P = 0.059) could improve predictive ability. The KDRI performs equal in the Dutch population. Discriminative ability of the KDRI indicates limited clinical use for adequate individualized decisions. An updated KDRI may contribute to a standardized policy meeting the growing demand of donor kidneys in the Eurotransplant region.

Big Data, Predictive Analytics, and Quality Improvement in Kidney Transplantation: A Proof of Concept.

We sought proof of concept of a Big Data Solution incorporating longitudinal structured and unstructured patient-level data from electronic health records (EHR) to predict graft loss (GL) and mortality. For a quality improvement initiative, GL and mortality prediction models were constructed using baseline and follow-up data (0-90 days posttransplant; structured and unstructured for 1-year models; data up to 1 year for 3-year models) on adult solitary kidney transplant recipients transplanted during 2007-2015 as follows: Model 1: United Network for Organ Sharing (UNOS) data; Model 2: UNOS & Transplant Database (Tx Database) data; Model 3: UNOS, Tx Database & EHR comorbidity data; and Model 4: UNOS, Tx Database, EHR data, Posttransplant trajectory data, and unstructured data. A 10% 3-year GL rate was observed among 891 patients (2007-2015). Layering of data sources improved model performance; Model 1: area under the curve (AUC), 0.66; (95% confidence interval [CI]: 0.60, 0.72); Model 2: AUC, 0.68; (95% CI: 0.61-0.74); Model 3: AUC, 0.72; (95% CI: 0.66-077); Model 4: AUC, 0.84, (95 % CI: 0.79-0.89). One-year GL (AUC, 0.87; Model 4) and 3-year mortality (AUC, 0.84; Model 4) models performed similarly. A Big Data approach significantly adds efficacy to GL and mortality prediction models and is EHR deployable to optimize outcomes.

Effect of Replacing Race With Apolipoprotein L1 Genotype in Calculation of Kidney Donor Risk Index.

Renal allografts from deceased African American donors with two apolipoprotein L1 gene (APOL1) renal-risk variants fail sooner than kidneys from donors with fewer variants. The Kidney Donor Risk Index (KDRI) was developed to evaluate organ offers by predicting allograft longevity and includes African American race as a risk factor. Substituting APOL1 genotype for race may refine the KDRI. For 622 deceased African American kidney donors, we applied a 10-fold cross-validation approach to estimate contribution of APOL1 variants to a revised KDRI. Cross-validation was repeated 10 000 times to generate distribution of effect size associated with APOL1 genotype. Average effect size was used to derive the revised KDRI weighting. Mean current-KDRI score for all donors was 1.4930 versus mean revised-KDRI score 1.2518 for 529 donors with no or one variant and 1.8527 for 93 donors with two variants. Original and revised KDRIs had comparable survival prediction errors after transplantation, but the spread in Kidney Donor Profile Index based on presence or absence of two APOL1 variants was 37 percentage points. Replacing donor race with APOL1 genotype in KDRI better defines risk associated with kidneys transplanted from deceased African American donors, substantially improves KDRI score for 85-90% of kidneys offered, and enhances the link between donor quality and recipient need.

Kidney Donor Risk Index as the Predictor for the Short-term Clinical Outcomes After Kidney Transplant From Deceased Donor With Acute Kidney Injury

BackgroundThe Kidney Donor Risk Index (KDRI) scoring system for deceased donors has been widely introduced for postoperative evaluation of graft function. We analyzed the usefulness of the KDRI in deceased donors with acute kidney injury (AKI). MethodsForty-nine recipients from deceased donors with AKI between January 2009 and December 2014 were reviewed retrospectively. Data collected from donor medical records included age, height, weight, hypertension or diabetes history, cause of death, serum creatinine (sCr), and donation after cardiac death. Graft function data including sCr, estimated glomerular filtration rate (eGFR), and acute rejection episodes were monitored for 1 year. Correlations between KDRI score and factors indicating graft function were analyzed. A cutoff value for KDRI score was calculated using a receiver operating characteristic (ROC) curve for significant graft function. ResultsThe mean ages of donors and recipients were 46.81 ± 13.13 and 47.69 ± 11.43, respectively. The mean KDRI score was 1.24 ± 0.40. Univariable analysis of KDRI score and factors indicating graft function indicated that sCr at 6 to 12 months, eGFR at 1 year, and slow graft function (SGF) had statistical significance. The ROC curve of KDRI score for SGF showed an optimal cutoff value of 1.20, with sensitivity of 69.2% and specificity of 69.4% (area under the curve = 0.75) in deceased donors with AKI. ConclusionsKDRI score in deceased donors with AKI was correlated with postoperative graft values including eGFR and SGF. KDRI could be used as a predictor for the short-term clinical outcome after kidney transplant from deceased donor with AKI.

Epidemiology of Kidney Discard from Expanded Criteria Donors Undergoing Donation after Circulatory Death.

The broader use of combined expanded criteria donor and donation after circulatory death (ECD/DCD) kidneys may help expand the deceased donor pool. The purpose of our study was to evaluate discard rates of kidneys from ECD/DCD donors and factors associated with discard. ECD/DCD donors and kidneys were evaluated from January 1, 2000 to March 31, 2011 using data from the Scientific Registry of Transplant Recipients. The kidney donor risk index was calculated for all ECD/DCD kidneys. Multivariable logistic regression models were used to determine risk factors for discarding both donor kidneys. The Kaplan-Meier product limit method and the log-rank statistic were used to assess the cumulative probability of graft failure for transplants from ECD/DCD donors where the mate kidney was discarded versus both kidneys were used. There were 896 ECD/DCD donors comprising 1792 kidneys. Both kidneys were discarded in 44.5% of donors, whereas 51.0% of all available kidneys were discarded. The kidney donor risk index scores were higher among donors of discarded versus transplanted kidneys (median, 1.82; interquartile range, 1.60, 2.07 versus median, 1.67; interquartile range, 1.49, 1.87, respectively; P<0.001); however, the distributions showed considerable overlap. The adjusted odds ratios for discard were higher among donors who were older, diabetic, AB blood type, and hepatitis C positive. The cumulative probabilities of total graft failure at 1, 3, and 5 years were 17.3%, 36.5%, and 55.4% versus 13.8%, 24.7%, and 40.5% among kidneys from donors where only one versus both kidneys were transplanted, respectively (log rank P=0.04). Our study shows a significantly higher discard rate for ECD/DCD kidneys versus prior reports. Some discarded ECD/DCD kidneys may be acceptable for transplantation. Additional studies are needed to evaluate the factors that influence decision making around the use of ECD/DCD kidneys.

Determinants of Discard of Kidneys From Expanded Criteria Donors Undergoing Donation After Circulatory Death.

Background The use of combined expanded criteria donor (ECD) and donation after circulatory death (DCD) kidneys is a potential strategy to expand the donor pool. Prior research showed that DCD kidneys have a slightly increased risk of graft failure vs non-DCD kidneys, but the relative risk was not significantly greater amongst ECD vs non-ECD kidneys. The Kidney Donor Risk Index (KDRI) in the ECD/DCD group was similar to those in the ECD/non-DCD group, suggesting careful selection of ECD/DCD kidneys. Methods A cross sectional study of ECD/DCD kidneys recovered from adult donors from 2000 to 2011 was conducted using the SRTR. Donor characteristics and KDRI scores of discarded and transplanted ECD/DCD kidneys were assessed and multivariable logistic regression models were used to determine the odds of discard based on donor factors. Results There were 894 ECD/DCD kidneys included in the study, of which 34.2% were discarded. The median KDRI in transplanted vs discarded organs was 1.78 (IQR 0.69) vs 1.98 (IQR 0.89), respectively (P < 0.001) although the distribution of KDRI scores between discarded and transplanted kidneys showed considerable overlap.Figure: No Caption available.In logistic regression models, the odds of discard were higher if ECD/DCD kidneys were recovered from diabetic donors (OR 1.68 [95% CI 1.16, 2.45] P = 0.007) and hepatitis B or C positive donors (OR 2.73 [95% CI 1.37, 5.43] and OR 4.16 [95% CI 1.56, 11.08], P = 0.004 for both). Pulsatile machine perfusion was associated with decreased odds of discard (OR 0.32 [95% CI 0.22, 0.44], P < 0.001). Other factors such as age, race, death by CVA, hypertension and weight were not associated with increased odds of discard. Conclusions This study demonstrates a high discard rate of ECD/DCD kidneys, some of which may be acceptable for transplantation given their favorable donor characteristics and KDRI scores.

Does Expanded Criteria Donor Status Modify the Outcomes of Kidney Transplantation From Donors After Cardiac Death?

The outcomes of kidney transplants that simultaneously exhibit donation after cardiac death (DCD) and expanded criteria donor (ECD) characteristics have not been well studied. We examined the outcomes of DCD versus non-DCD kidney transplants as a function of ECD status and the kidney donor risk index (KDRI). A cohort study of 67816 deceased donor kidney transplant recipients (KTR), including 562 ECD/DCD KTR, from January 1, 2000 to December31, 2009 was conducted using the Scientific Registry of Transplant Recipients. In a multivariable Cox proportional hazards model, the modestly increased risk of total graft failure in DCD versus non-DCD KTR was not significantly modified by ECD status (hazard ratio1.07 [95% CI: 1.01, 1.15] for non-ECD vs. 1.21 [95% CI: 1.04, 1.40] for ECD, p for interaction = 0.14).Moreover, the hazard ratios did not significantly vary by KDRI quintiles (p = 0.40). Similar trends were seen for death-censored graft failure and death with graft function. In conclusion, ECD status or higher KDRI score did not appreciably increase the relative hazard of adverse graft and patient outcomes in DCD KTR. These findings suggest that the judicious use of ECD/DCD donor kidneys may be an appropriate strategy to expand the donor pool.