Analysis of donor factors for clinical prediction of recipient after deceased donor renal transplantation in South Korea

Abstract

Background: There is little data on allograft survival based on deceased donor characteristics outside the United States. Conservative use of deceased donors based on concern for longer term allograft outcomes likely increases the discard rate of deceased donor kidneys despite a severe international deficit of kidney donors. Using South Korea as a model, we analyzed deceased donor characteristics using 1-year creatinine in the recipient as a surrogate marker for longer term outcomes. Methods: We analyzed a total 2,858 cases contained within the Korean Organ Transplant Registry data which had conducted deceased donor renal transplant from 2009 to 2017. Univariate, multivariate linear regression analysis and five-fold cross validation was performed to make a formula for estimating the serum creatinine of the recipient for 1 year after deceased donor kidney transplant. Results: Univariate analysis indicated a number of different factors were significant in determining outcome, however only donor age, donor serum creatinine and current smoking status without hypertension were statistically significant in a multivariate model for predicting serum creatinine of the recipient after 1 year of kidney transplant. We also found that serum creatinine at 1 year predicted 3-year outcomes in a log-rank test. Conclusions: Currently deceased donor kidney transplant outcomes are extremely good in South Korea (despite a much longer period on dialysis prior to transplant) compared to the United States. Given significant differences in cultural, economic, medical and racial characteristics compared to the US the Korean prediction model obtained from this study relies on checking only three donor factors, and thus can be obtained relatively quickly and conveniently and yet provides more information to the recipient candidates before transplant. In particular, we also believe this study indicates that there is underutilization of potential decreased donors in Korea and that a wider pool of deceased donors could be used safely.