Clinical significance of the Kidney Donor Profile Index in deceased donors for prediction of post-transplant clinical outcomes: A multicenter cohort study

Lee, Jong Hoon; Park, Woo Yeong; Kim, Young Soo; Choi, Bum Soon; Park, Cheol Whee; Yang, Chul Woo; Kim, Yong Soo; Jin, Kyubok; Han, Seungyeup; Chung, Byung Ha

doi:10.1371/journal.pone.0205011

Cited by 7 publications

(12 citation statements)

References 32 publications

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“…Previously Lee et al . [14] showed a strong linear relationship between KDPI and median eGFR. Additionally, the group from the University of Virginia showed that kidney graft function, as measured by GFR at 6 months post‐kidney transplant, is a powerful predictor of long‐term post‐transplant outcomes [15].…”

Section: Discussionsupporting

confidence: 84%

Donor hepatitis C antibody positivity misclassifies kidney donor profile index in non‐hepatitis C‐infected donors: time to revise the kidney donor profile index – a retrospective cohort study

et al. 2020

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Summary The kidney donor profile index (KDPI) defines an hepatitis C (HCV) positive donor based on HCV antibody (Ab) and/or nucleic acid amplification test (NAT) positivity, with donors who are not actively infected (Ab+/NAT−) also classified as HCV positive. From Scientific Registry of Transplant Recipients dataset, we identified HCV‐negative recipients, who received a kidney transplant from HCV Ab+/NAT− (n = 116) and HCV Ab−/NAT− (n = 25 574) donor kidneys. We then compared recipients’ estimated glomerular filtration rate (eGFR) at 6 months in matched cohorts, using combined exact matching (based on KDPI) and propensity score matching. We created two separate matched cohorts: for the first cohort, we used the allocation KDPI, while for the second cohort we used an optimal KDPI, where the HCV component of KDPI was considered negative in Ab+/NAT− patients. The mean ± SD age of the allocation KDPI‐matched cohort at baseline was 59 ± 10 years, 69% were male, 61% were white. Recipients’ eGFR at 6 months after transplantation was significantly higher in the HCV Ab+/NAT− group compared to the HCV Ab−/NAT− group (61.1 ± 17.9 vs. 55.6 ± 18.8 ml/min/1.73 m2, P = 0.011) in the allocation KDPI‐matched cohort, while it was similar (61.8 ± 19.5 vs. 62.1 ± 20.1 ml/min/1.73 m2, P = 0.9) in the optimal KDPI‐matched cohort. Recipients who received HCV Ab positive, but NAT‐negative donor kidneys did not experience worse 6‐month eGFR than correctly matched HCV Ab−/NAT− recipients.

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Section: Discussionsupporting

confidence: 84%

Donor hepatitis C antibody positivity misclassifies kidney donor profile index in non‐hepatitis C‐infected donors: time to revise the kidney donor profile index – a retrospective cohort study

et al. 2020

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“…In our previous study, we found that high KDPI scores in DDs can be associated with adverse allograft outcomes 12 . However, in that study, we did not consider recipient factors, which can also interact with donor factors to affect allograft outcomes 9 .…”

Section: Discussionmentioning

confidence: 95%

“…For this, we compared the clinical outcomes of KTs according to the KDPI scores in DDs and the age of kidney transplant recipients (KTRs). We also determined if high KDPI scores in DDs showed an interaction with recipient age using established multicenter cohort data [11][12][13][14] .…”

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confidence: 99%

Impact of Kidney Donor Profile Index Scores on Post-Transplant Clinical Outcomes Between Elderly and Young Recipients, A Multicenter Cohort Study

Park

Kim

et al. 2020

Sci Rep

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We investigated if clinical outcomes after kidney transplantation (KT) from deceased donors (DDs) with high Kidney Donor Profile Index (KDPI) can be different according to the age of KT recipients (KTRs). Six-hundred fifty-seven KTRs from 526 DDs were included from four transplant centers. We divided KTRs into elderly-KTR and young-KTR groups based on age 60 and each group was subdivided into high-or low-KDPI subgroup based on KDPI score of 65%. We compared short-term and long-term clinical outcomes among those four subgroups (low KDPI-young KTR, low KDPI-elderly-KTR, high KDPI-young-KTR, high KDPI-elderly-KTR). In short-term outcomes including acute rejection, BK virus and CMV infection, there was no significant difference among the four subgroups. In the long-term outcomes, the development of cardiovascular disease was higher in the high KDPI-elderly-KTR group than the other groups. In comparison of allograft survival rate, the high KDPI-young KTR subgroup showed highest risk for allograft failure and there was significant interaction between high-KDPI donors and young-KTR on allograft survival rate (P = 0.002). However, there was no significant difference in comparison of the patient survival rate. In conclusion, clinical impact of high-KDPI in DDs on posttransplant allograft survival may be less significant in elderly-KTR than in young-KTR. The number of elderly patients with end-stage renal disease (ESRD) has increased globally parallel to the increases in mean life expectancy over the past several decades 1,2. According to the Korean ESRD Registry data, only 8% of the total number of ESRD patients were older than age 60 in 2004, which increased rapidly to 43.9% in 2016. Accordingly, the proportion of elderly patients undergoing kidney transplantation (KT) showed an almost six-fold increase, from 2% in 2000 to 11.6% in 2016 3. In terms of clinical outcomes, KT offers a better quality of life, cardiovascular stability, and improved survival compared to peritoneal dialysis (PD) or hemodialysis (HD) in

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“…The kidney profile donor index (KDPI) score has been used to assess the risk of graft loss of any given donor compared to the median population of donors using 10 donor-specific criteria including age, sex, height, weight, history, and duration of hypertension and diabetes, hepatitis C virus (HCV) status, donation after cardiac death (DCD) status, and donor cause of death. Therefore, the KDPI index has been used to identify organs that may have decreased survival compared to the SCD groups, and scores of >=85 are thought to be associated with poorer long-term allograft survival [ 10 ]. A donor kidney with a KDPI score of ≥85 has been characterized in the literature as having similar donor characteristics as an ECD kidney [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Assessing the Outcome of Adult Kidney Transplantation from a Deceased Expanded Criteria Donor: A Descriptive Study

Alshahrani¹,

Alotaibi²,

Bhutto³

2020

Cureus

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Background End-stage renal disease (ESRD) creates a great burden on the quality of life. Patients after kidney transplantation have been reported to have a greater quality of life and better outcomes health outcomes. Therefore, it is important to optimize the best method of following well-constructed criteria such as the expanded criteria donor (ECD) to reduce the chances of rejection rate and deaths post-transplantation particularly in elderly patients in conjunction with the kidney profile donor index (KDPI). Methods This is a retrospective descriptive study of all patients who received kidney transplantation from a deceased donor from the ECD as well as ECD with donation after cardiac death (DCD) at St. Joseph Health Care Hospital over a 24 month time period from January 2017 to January 2019. All adult recipients from standard criteria donor (SCD) and living donors were excluded from the study. Results The study included 60 patients with 36 (60%) from the ECD and 24 (40%) were from the ECD/DCD group. The most common cause of ESRD among recipients was diabetes mellitus (DM) involving 23 (38.3%) of the patients. The creatinine outcome was the highest in the ECD/DCD group at one month (211 ± 71) and the lowest creatinine recorded was also in the ECD/DCD at 12 months (160 ± 78). Lastly, only four patients died in 12 months and only six recipients reported graft loss over 12 months. Conclusion Descriptive data of the included ECD/DCD showed increase trend in survivability of the recipients when used among the elderly, giving us more insight on the benefits of ECD/DCD transplantation.

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Clinical significance of the Kidney Donor Profile Index in deceased donors for prediction of post-transplant clinical outcomes: A multicenter cohort study

Cited by 7 publications

References 32 publications

Donor hepatitis C antibody positivity misclassifies kidney donor profile index in non‐hepatitis C‐infected donors: time to revise the kidney donor profile index – a retrospective cohort study

Donor hepatitis C antibody positivity misclassifies kidney donor profile index in non‐hepatitis C‐infected donors: time to revise the kidney donor profile index – a retrospective cohort study

Impact of Kidney Donor Profile Index Scores on Post-Transplant Clinical Outcomes Between Elderly and Young Recipients, A Multicenter Cohort Study

Assessing the Outcome of Adult Kidney Transplantation from a Deceased Expanded Criteria Donor: A Descriptive Study

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