KDPI and Donor Selection

Gupta, Aditi; Chen, G.; Kaplan, Bruce

doi:10.1111/ajt.12930

Cited by 27 publications

(22 citation statements)

References 3 publications

(2 reference statements)

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“…Our results about graft survival of pediatric donor kidneys are consistent with other studies, (5–8,14,15) and show that KDPI takes an oversimplified approach to a complex donor population. There are several reasons why KDPI is not a good predictor of graft performance for kidneys from pediatric donors.…”

Section: Discussionsupporting

confidence: 91%

“…However, Gupta and colleagues contend that KDPI was not intended for that purpose either: “KDPI was meant to rank order the quality of kidneys as defined by an aggregate population relative risk. It was never meant to be utilized as a discriminatory tool to determine acceptance/rejection of a particular kidney offer.”(8)…”

Section: Discussionmentioning

confidence: 99%

“…Also, in the KDPI algorithm, continuous covariates for donor size were used despite evidence to suggest that categorical covariates may be more predictive of outcome for pediatric donors. (5–8) We hypothesized that 1) KDPI would not accurately predict graft survival of pediatric donor kidneys; and 2) alternative indices could be developed that could outperform KDPI for pediatric donor kidneys.…”

Section: Introductionmentioning

confidence: 99%

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Kidney Donor Profile Index Does Not Accurately Predict the Graft Survival of Pediatric Deceased Donor Kidneys

2016

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Background The new deceased donor kidney allocation algorithm uses a Kidney Donor Profile Index (KDPI) based on donor characteristics to predict graft survival and divides kidneys into 4 quality groups (i.e., KDPI-A, -B, -C, and -D). Pediatric kidneys constitute 10–12% of deceased donor kidneys. We hypothesized that KDPI would not accurately predict pediatric donor graft survival and superior predictive models could be created. Methods Scientific Registry of Transplant Recipients data for years 2000–2010 for transplants from child (<10 years) and adolescent (10–17 years inclusive) donors into first-time adult recipients were analyzed with graft failure as the principle outcome. Two novel indices, Child Donor Index (CDI) and Adolescent Donor Index (ADI), were developed using stepwise variable deletion to identify significant model covariates in a Cox Regression. Pediatric donor kidneys were then classified into the four quality groups based on both KDPI and CDI/ADI scores. The performance of the KDPI, CDI and ADI models were compared with respect to the four quality groups defined by the new allocation system. Results KDPI did not effectively discriminate between quality groups (p> 0.05 for all but one comparison) in Kaplan-Meier survival analyses. CDI and ADI included novel variables (e.g., body mass index percentiles) and successfully discriminated between quality groups (p<0.05 by log rank test). The Net Reclassification Index showed improvement when switching from KDPI to CDI and ADI, with values of 0.09 (p<0.001) and 0.073 (p<0.001) respectively. Conclusion KDPI does not accurately predict pediatric kidney graft survival. Alternative indices can improve allocation efficiency.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Kidney Donor Profile Index Does Not Accurately Predict the Graft Survival of Pediatric Deceased Donor Kidneys

2016

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“…When examining death‐censored graft and patient survival rates, our data validate the original hypothesis that KDPI can be used to estimate all‐cause allograft survival . We noted that graft and patient 5‐year survival was highest in the kidneys with KDPI ≤60 and lowest in those with KDPIs ≥85.…”

Section: Discussionsupporting

confidence: 76%

The impact of kidney donor profile index on delayed graft function and transplant outcomes: A single‐center analysis

Zens

Danobeitia

Leverson

et al. 2018

Clinical Transplantation

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The KDPI system is an accurate predictor of donor contributions to transplant outcomes. Recipients of DBD kidneys experience an increase in the rate of DGF as their KDPI increases. DCD kidneys have higher DGF rates than their DBD counterparts with similar KDPIs. Patients with documented post-transplant DGF had between 3- and 5-year shorter graft half-lives when compared to recipients that did not experience DGF. Initiatives to reduce the rate of DGF could provide a significant impact on graft survival and result in a reduction in the number of patients requiring retransplant.

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“…The Kidney Donor Profile Index (KDPI) was designed to classify deceased donor characteristics and estimate the risk of graft failure to the deceased donor kidney transplant recipient [91, 92]. Massie et al designed a similar risk index to classify living donor kidneys to enable health professionals to quantify the health risk for their recipient [93].…”

Section: Introductionmentioning

confidence: 99%

Decision Aids to Increase Living Donor Kidney Transplantation

2017

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Purpose of review For the more than 636,000 adults with end-stage renal disease (ESRD) in the U.S., kidney transplantation is the preferred treatment compared to dialysis. Living donor kidney transplantation (LDKT) comprised 31% of kidney transplantations in 2015, an 8% decrease since 2004. We aimed to summarize the current literature on decision aids that could be used to improve LDKT rates. Recent findings Decision aids are evidence-based tools designed to help patients and their families make difficult treatment decisions. LDKT decision aids can help ESRD patients, patients’ family and friends, and healthcare providers engage in treatment decisions and thereby overcome multifactorial LDKT barriers. Summary We identified 12 LDKT decision aids designed to provide information about LDKT, and/or to help ESRD patients identify potential living donors, and/or to help healthcare providers make decisions about treatment for ESRD or living donation. Of these, 4 were shown to be effective in increasing LDKT, donor inquiries, LDKT knowledge, and willingness to discuss LDKT. Although each LDKT decision aid has limitations, adherence to decision aid development guidelines may improve decision aid utilization and access to LDKT.

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KDPI and Donor Selection

Cited by 27 publications

References 3 publications

Kidney Donor Profile Index Does Not Accurately Predict the Graft Survival of Pediatric Deceased Donor Kidneys

Kidney Donor Profile Index Does Not Accurately Predict the Graft Survival of Pediatric Deceased Donor Kidneys

The impact of kidney donor profile index on delayed graft function and transplant outcomes: A single‐center analysis

Decision Aids to Increase Living Donor Kidney Transplantation

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