Outcomes of Adult Dual Kidney Transplants by KDRI in the United States

Abstract

UNOS guidelines provide inadequate discriminatory criteria for kidneys that should be transplanted as single (SKT) versus dual (DKT). We evaluated the utility of the kidney donor risk index (KDRI) to define kidneys with better outcomes when transplanted as dual. Using SRTR data from 1995 to 2010 of de novo KTX recipients of adult deceased-donor kidneys, we examined outcomes of SKT and DKT stratified by KDRI group 1.4 (n ¼ 49 294), 1.41-1.8 (n ¼ 15 674), 1.81-2.2 (n ¼ 6523) and >2.2 (n ¼ 2791). DKT of kidneys with KDRI >2.2 was associated with significantly better overall graft survival [adjusted hazard ratio (aHR) 0.83, 95% confidence interval (CI) 0.72-0.96] compared to single kidneys with KDRI >2.2. DKT was associated with significantly decreased odds of delayed graft function (top 2 KDRI categories) and significantly decreased odds of 1-year serum creatinine level >2 mg/dL (top 3 KDRI categories). Among SKT and DKT from KDRI >2.2 there were 16.1 and 13.9 graft losses per 100 patient follow-up years, respectively. KDRI >2.2 is a useful discriminatory cut-off for the determination of graft survival benefit with the use of DKT; however, the benefit of increased graft years was less than half of single kidneys from donors in the same KDRI range.

Kidneys at Higher Risk of Discard: Expanding the Role of Dual Kidney Transplantation

“…They urged a more aggressive and consistent approach to the use of DKT. More recently, Klair et al (31) analyzed the UNOS database from 1995 to 2010 and found better graft survival for DKT for organs with KDRI >2.2, suggesting that the utilization of these marginal organs as dual organs should be considered for certain recipient categories to improve outcomes and resource utilization.…”

R Open Source Programming Code for Calculation of the Kidney Donor Profile Index and Kidney Donor Risk Index

“…Of note, even the recipients of kidneys with KDPI > 85% were at a much lower risk of death 2 years after transplant compared to those remaining on dialysis waiting for low-KDPI kidneys [13]. Moreover, such ECDs could be considered for the double kidney transplantation to a single recipient that provide better patient and graft survival in comparison to transplantation of such kidneys to 2 recipients [14, 15], and the use of the additional pre-transplant donor biopsy morphology score [16] secures the kidney transplantation from a high KDPI donor that otherwise may be discarded [17-20] and helps to allocate a donor organ to single or double transplantation. The results of the aforementioned studies highlight the important limitation of the current version of KDPI that could overestimate the prognostic weight of age based on the generalization from the total deceased donor population, and do not assume the specific constellation of parameters of a given donor.…”

Dual Kidney Transplantation: A Review of Past and Prospect for Future

“…Therefore one must be cautious while taking decision on the basis of KDPI. However, Klair et al used KDRI for DKT and concluded that KDRI > 2.2 is a useful discriminatory cut-off for the determination of graft survival [28]. …”

“…If e GFR is greater than 60 ml/minute or KDRI is less than 2.2 then kidneys should go for SKT [24, 28]. If e GFR is less than 60 ml/minute or KDRI is greater than 2.2 then these patients should undergo biopsy to decide for SKT versus DKT.…”

“…Results of most studies showed that elderly patients who had DKT tend to have lower metabolic rate and low body mass index than the average SKT patients [16, 19, 20, 24, 28, 31, 32]. DKT is considered better for age and weight matched recipient.…”