Kidney donor risk index is a good prognostic tool for graft outcomes in deceased donor kidney transplantation with short, cold ischemic time

Jeong, Jong Cheol; Koo, Tai Yeon; Jeon, Hee Jung; Kwon, Hyuk Yong; Kim, Yoonjung; Ryu, Hyun Jin; Ahn, Curie; Yang, Jaeseok

doi:10.1111/ctr.12318

Cited by 31 publications

(18 citation statements)

References 27 publications

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“…Two studies from Korea have also assessed KDRI. 17 , 18 In each, KDRI was calculated for their deceased donors, and a KDRI cutoff value (median KDRI of 1.119 17 or an arbitrary cutoff value of 1.4 18 ) was used to classify “higher” vs “lower” risk. Both studies highlighted that the higher KDRI group was associated with a higher risk of graft failure relative to the lower KDRI group.…”

Section: Discussionmentioning

confidence: 99%

Is the Kidney Donor Risk Index a Useful Tool in Non-US Patients?

Young

Knoll

McArthur

et al. 2018

Can J Kidney Health Dis

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Background:Deceased donor kidney allocation in the United States is guided by the Kidney Donor Risk Index (KDRI). The generalizability of the KDRI beyond the United States has not been widely studied.Objective:To assess the generalizability of the KDRI in a cohort of non-US (Canadian) deceased donor kidney transplant recipients.Design:Population-based retrospective cohort study.Setting:Ontario, Canada.Patients:Recipients of deceased donor kidneys from January 1, 2005, to March 31, 2011.Methods:Using administrative data, we analyzed a cohort of deceased donor kidney recipients in Ontario, Canada. The Kaplan-Meier method and Cox proportional hazards models were used to assess the relationship between KDRI and the outcomes of graft loss and death. KDRI was modeled continuously and categorically. The ability of models with KDRI to predict recipient outcomes beyond donor age was also explored. Model discrimination was assessed using c-statistics, evaluated at 5 years of follow-up.Results:A total of 1299 consecutive deceased donor kidney transplant recipients were included. The median follow-up was 5.5 years. Mean donor age increased from 27 to 64 years across ascending KDRI quintiles. The adjusted relative hazards (95% confidence interval) for total graft loss from Q2 to Q5 (referent = Q1) were 1.27 (0.89-1.80), 1.58 (1.13-2.22), 1.43 (1.01-2.02), and 2.15 (1.54-2.99), respectively. Increased relative hazards across KDRI quintiles were also observed for death-censored graft loss, but not death with graft function. All-cause mortality was increased for the highest KDRI quintile only. In this cohort, a model with KDRI performed better than a model with donor age alone (P = .009).Limitations:Large health care databases may have precluded the complete capture of covariate data.Conclusions:In conclusion, the KDRI is generalizable to Canadian patients in Ontario and may help inform risk assessment beyond donor age. The performance of KDRI in other non-US settings, and the need for additional model refinement, warrants further study.

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Section: Discussionmentioning

confidence: 99%

Is the Kidney Donor Risk Index a Useful Tool in Non-US Patients?

Young

Knoll

McArthur

et al. 2018

Can J Kidney Health Dis

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“…Donor characteristics have been shown to be associated with predicting the relative risk of graft failure. Several donor risk scoring systems have been developed to predict graft outcomes in deceased and living donor transplantation in high income countries . We developed a living donor risk model in a low resource setting to predict the allograft and patient outcomes of living kidney donor transplantation.…”

Section: Discussionmentioning

confidence: 99%

“…Several donor risk scoring systems have been developed to predict graft outcomes in deceased and living donor transplantation in high income countries. [20][21][22][23] We developed a living donor risk model in a low resource setting to predict the allograft and patient outcomes of living kidney donor transplantation. Using records from over 2000 living donor, we have shown that donor age, donor creatinine clearance, nephron dose (estimated by donor/recipient body weight ratio) and HLA status are the key determinants for longer term patient and graft outcomes.…”

Section: Discussionmentioning

confidence: 99%

Living donor risk model for predicting kidney allograft and patient survival in an emerging economy

et al. 2018

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Similar to findings in high income countries, our study suggests that donor characteristics such as age, nephron dose, creatinine clearance and HLA match are important factors that determine the long-term patient and graft survival in low income countries. However, other crucial but undefined factors may play a role in determining the overall risk of graft failure and mortality in living kidney donor transplant recipients.

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“…Preimplantation or zero-time biopsy data were not available since there is no national consensus on how to perform, standardize, and merge this information including the pragmatic recommendation to do this according to the Banff classification in line with all other transplant biopsies taken later on [ 37 , 38 ]. Preimplantation biopsy is not done systematically in all ET countries including Germany at this moment due to the fact that there is general agreement in the ET community that the added value of routine kidney biopsies for evaluating donor kidney quality is limited if it comes to predicting intermediate and long-term function of the donated kidneys.…”

Section: Discussionmentioning

confidence: 99%

Influence of Deceased Donor and Pretransplant Recipient Parameters on Early Overall Kidney Graft-Survival in Germany

Fischer-Fröhlich

Kutschmann

Feindt³

et al. 2015

Journal of Transplantation

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Background. Scarcity of grafts for kidney transplantation (KTX) caused an increased consideration of deceased donors with substantial risk factors. There is no agreement on which ones are detrimental for overall graft-survival. Therefore, we investigated in a nationwide multicentre study the impact of donor and recipient related risks known before KTX on graft-survival based on the original data used for allocation and graft acceptance. Methods. A nationwide deidentified multicenter study-database was created of data concerning kidneys donated and transplanted in Germany between 2006 and 2008 as provided by the national organ procurement organization (Deutsche Stiftung Organtransplantation) and BQS Institute. Multiple Cox regression (significance level 5%, hazard ratio [95% CI]) was conducted (n = 4411, isolated KTX). Results. Risk factors associated with graft-survival were donor age (1.020 [1.013–1.027] per year), donor size (0.985 [0.977–0.993] per cm), donor's creatinine at admission (1.002 [1.001–1.004] per µmol/L), donor treatment with catecholamine (0.757 [0.635–0.901]), and reduced graft-quality at procurement (1.549 [1.217–1.973]), as well as recipient age (1.012 [1.003–1.021] per year), actual panel reactive antibodies (1.007 [1.002–1.011] per percent), retransplantation (1.850 [1.484–2.306]), recipient's cardiovascular comorbidity (1.436 [1.212–1.701]), and use of IL2-receptor antibodies for induction (0.741 [0.619–0.887]). Conclusion. Some donor characteristics persist to impact graft-survival (e.g., age) while the effect of others could be mitigated by elaborate donor-recipient match and care.

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Kidney donor risk index is a good prognostic tool for graft outcomes in deceased donor kidney transplantation with short, cold ischemic time

Abstract: KDRI has greater predictive value for short-term outcomes in DDKT with short CIT than the SCD/ECD designation or pathology.

Cited by 31 publications

References 27 publications

Is the Kidney Donor Risk Index a Useful Tool in Non-US Patients?

Is the Kidney Donor Risk Index a Useful Tool in Non-US Patients?

Living donor risk model for predicting kidney allograft and patient survival in an emerging economy

Influence of Deceased Donor and Pretransplant Recipient Parameters on Early Overall Kidney Graft-Survival in Germany

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