The Combined Risk of Donor Quality and Recipient Age

Hernández, Roland A.; Malek, Sayeed K.; Milford, Edgar L.; Finlayson, Samuel R.G.; Tullius, Stefan G.

doi:10.1097/tp.0000000000000181

Cited by 35 publications

(10 citation statements)

References 13 publications

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“… 19 However, this and other previous studies investigating the impact of KDPI on recipient outcomes have not specifically evaluated differences based on donor and recipient diabetes status. 7 , 19 - 21 This information will allow us to better inform patients of underlying implications of accepting these organs based on the recipients’ risk factors, outside of that information provided by the KDPI alone.…”

Section: Discussionmentioning

confidence: 99%

National outcomes of kidney transplantation from deceased diabetic donors

Cohen

Bloom

Reese

et al. 2016

Kidney International

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Use of deceased diabetic donor kidneys has increased over recent decades. However, scarce patient and allograft survival data are available taking into account recipient diabetes status. Here we performed a retrospective cohort study using data from the United Network of Organ Sharing in patients transplanted from 1994 to 2014. Multivariable Cox regression assessed recipient outcomes of 9, 074 diabetic versus 152, 555 non-diabetic donor kidneys. Recipients of diabetic donor kidneys had elevated rates of all-cause allograft failure (hazard ratio 1.21, 95% confidence interval 1.16-1.26) and death (1.19, 1.13-1.24) compared to recipients of kidneys from non-diabetic donors. Younger recipients of diabetic donor kidneys had worse allograft survival than older recipients of non-diabetic donor kidneys. There was significant interaction between donor and recipient diabetes status. To minimize the effect of unmeasured confounders, we used paired analyses of recipients of mate-kidneys from the same donor, with one diabetic recipient and the other non-diabetic. Among discordant recipient pairs of diabetic donor kidneys, diabetic recipients had significantly higher risk of allograft failure (1.27, 1.05-1.53) and death (1.53, 1.22-1.93) than non-diabetic recipients. After stratifying by Kidney Donor Profile Index risk category, diabetic recipients of diabetic donor kidneys continued to have worse allograft survival compared to all other patients. Thus, risks are associated with the use of diabetic donor kidneys. Understanding these risks will enable clinicians to better educate potential recipients.

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Section: Discussionmentioning

confidence: 99%

National outcomes of kidney transplantation from deceased diabetic donors

Cohen

Bloom

Reese

et al. 2016

Kidney International

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“…The mean age of recipient at KT was significantly higher in the high KDPI-KTR group than in in the low KDPI-KTR group. Most elderly candidates received KT from marginal donors because of the benefit of old for old KT and the prevention of death prior to KT during the waiting period for DDKT [30][31][32][33]. Since the presence of DM or HTN can suggest an underlying chronic tissue injury irrespective of allograft function, such donors could be diagnosed with CKD [34].…”

Section: Discussionmentioning

confidence: 99%

Impact of acute kidney injury in deceased donors with high Kidney Donor Profile Index on posttransplant clinical outcomes: a multicenter cohort study

Park

Chang

Kim

et al. 2021

Kidney Res Clin Pract

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Background: This study evaluated the impact of acute kidney injury (AKI) on posttransplant clinical outcomes for deceased donor (DD) kidney transplantation (KT) using the Kidney Donor Profile Index (KDPI) system. Methods: Overall, 657 kidney transplant recipients (KTRs) receiving kidneys from 526 DDs from four transplant centers were included. We divided them into the high and low KDPI donor groups by 65%, the KDPI score, and both groups were subdivided into the AKI-DDKT and non-AKI-DDKT subgroups according to AKI in DDs. Results: There was no significant difference in the incidence of delayed graft function (DGF) between the high and low KDPI-KTR groups; however, the AKI-DDKT subgroup showed significantly higher incidence of DGF than the non-AKI-DDKT subgroup in both groups (p = 0.001, p < 0.001, respectively). The death-censored graft survival rate was significantly lower in the high KDPI-KTR group than in the low KDPI-KTR group (p = 0.005). Only in the high KDPI-KTR group, the death-censored graft survival rate was significantly lower in the KT from DDs with AKI stage 3 than KT from DDs with non-AKI or AKI stage 1 or 2 (p = 0.040). The interaction between AKI stage 3 in DDs and high KDPI on the allograft outcome was significant (p = 0.002). Conclusion: KTs from DDs with AKI stage 3 showed an adverse impact on the allograft outcome in the high KDPI-KTR group. Therefore, DDs with a high KDPI score should be managed carefully so that severe AKI does not occur prior to KT.

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“…These analyses would be relevant as prior work has suggested that there may be a significant interaction by recipient characteristics, whereby the effect of KDRI on graft outcomes is less pronounced for older, diabetic, or black recipients. 23 , 24 Procurement kidney biopsies are not routinely performed across transplant centers in Canada; thus, the relevance of incorporating such data into risk prediction is not known.…”

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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The Combined Risk of Donor Quality and Recipient Age

Cited by 35 publications

References 13 publications

National outcomes of kidney transplantation from deceased diabetic donors

National outcomes of kidney transplantation from deceased diabetic donors

Impact of acute kidney injury in deceased donors with high Kidney Donor Profile Index on posttransplant clinical outcomes: a multicenter cohort study

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

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