Assessing the discrimination of the Kidney Donor Risk Index/Kidney Donor Profile Index scores for allograft failure and estimated glomerular filtration rate in Ireland’s National Kidney Transplant Programme

Abstract

Background The Kidney Donor Risk Index (KDRI)/Kidney Donor Profile Index (KDPI) is relied upon for donor organ allocation in the USA, based on its association with graft failure in time-to-event models. However, the KDRI/KDPI has not been extensively evaluated in terms of predictive metrics for graft failure and allograft estimated glomerular filtration rate (eGFR) outside of the USA. Methods We performed a retrospective analysis of outcomes in the Irish National Kidney Transplant Service Registry for the years 2006–13. Associations of the KDRI/KDPI score with eGFR at various time points over the follow-up and ultimate graft failure were modelled. Results A total of 772 patients had complete data regarding KDRI/KDPI calculation and 148 of these allografts failed over the follow-up. The median and 25–75th centile for KDRI/KDPI was 51 (26–75). On repeated-measures analysis with linear mixed effects models, the KDRI/KDPI (fixed effect covariate) associated with eGFR over 5 years: eGFR = −0.25 (standard error 0.02; P < 0.001). The variability in eGFR mathematically accounted for by the KDRI/KDPI score was only 21%. The KDRI/KDPI score did not add significantly to graft failure prediction above donor age alone (categorized as > and <50 years of age) when assessed by the categorical net reclassification index. Conclusions In this cohort, while the KDRI/KDPI was predictive of eGFR over the follow-up, it did not provide additive discrimination above donor age alone in terms of graft failure prediction. Therefore it is unlikely to help inform decisions regarding kidney organ allocation in Ireland.

Deep Learning Algorithms for the Prediction of Posttransplant Renal Function in Deceased-Donor Kidney Recipients: A Preliminary Study Based on Pretransplant Biopsy

“…In general, pretransplant donor scores, such as the deceased donor score (DDS), donor risk score (DRS), SCD/ECD, and KDRI/KDPI, have limited predictive performance for graft survival. The discriminative ability (C-index) is approximately 0.6 ( 23 , 24 ). However, adding posttransplant factors, such as eGFR, proteinuria, acute rejection, and allograft histological parameters, to prediction models significantly increases prediction accuracy ( 6 ), which indicates the importance of posttransplant management.…”

“…Our model using simple clinical features had a similar AUC of 0.69. Sexton and colleagues tested the discrimination of KDRI/KDPI for eGFR in the Ireland population, and according to the results, KDRI/KDPI was significantly associated with eGFR over 5 years but only accounted for 21% of eGFR variability over time ( 24 ). Overall, the predictive performance of using net clinical features is relatively poor.…”

Deceased Donor Characteristics and Kidney Transplant Outcomes

“…It contains components which can increase the risk quantification score but now demonstrate comparable outcomes (e.g., DCD). Translatability of the KDRI to population cohorts outside the United States may not be valid ( 38 , 39 ). Due to disparate survival outcomes observed for kidney failure patients treated with dialysis ( 40 , 41 ) versus kidney transplantation ( 42 ) in the United States versus elsewhere, and different utilization of deceased donors (e.g., greater use of older and DCD kidneys in the United Kingdom versus the United States for example) ( 43 ), generalizability may be invalid.…”

Assessment of Organ Quality in Kidney Transplantation by Molecular Analysis and Why It May Not Have Been Achieved, Yet

“…A recent study showed no significant difference in 5year death-censored graft survival between DCD KDPI 61-81 and DCD KDPI ≥ 85 when used for donation after cardiac death (DCD) kidneys (18). In line with the limited discriminative power regarding graft failure very high KDPI kidneys may reveal acceptable outcomes (21)(22)(23)(24). Another group showed 5-year graft survival of 91% using kidneys with KDPI score of 97% as dual transplants, highlighting that besides KDRI, nephron mass plays a major role with respect to graft survival (14,25).…”