US deceased kidney transplantation: Estimated GFR, donor age and KDPI association with graft survival

Pruett, Timothy L.; Vece, Gabriel; Carrico, Robert J.; Klassen, David K.

doi:10.1016/j.eclinm.2021.100980

Cited by 9 publications

(8 citation statements)

References 29 publications

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“…Those data indicate that DCD donation is playing an important role in contributing to an optimized utilization of available organs for transplantation in developed countries. Indeed, recent high-level data support that well-established DD programs show also favourable outcomes with DCD[ 13 , 14 ]. Ratios of DCD/BDD in addition to hospital and staff capacities may also play a role.…”

Section: Discussionmentioning

confidence: 99%

Global Impact of the COVID-19 Pandemic on Solid Organ Transplant

Kute

Tullius

Rane

et al. 2022

Transplantation Proceedings

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Introduction COVID-19 has drastically impacted the transplant services, but there is limited understanding the discrepancy in COVID-19 impact over various regions of the world. Methods We have explored the global observatory for organ donation and transplantation (GODT) data for assessing the transplant number changes between the calendar year 2019(n = 157301) and 2020(129681). Results There was disproportionate impact of COVID-19 for different areas of the world. Globally, there was a decline of 17.5%, in which deceased donation, kidney (20.9%), pancreas (16.2%), lung (12.7%), liver (11.3%) and heart (8%) transplantation declined disproportionally in different regions of the world. While pandemic affected almost all geographic regions and nations, but China and USA were mostly able to recover from the initial halt of the transplant practices by the pandemic, so that there was a cumulative increase in transplant numbers. Conclusion Our data, shows that developing nations lagged behind and developed nations have been able to recover their transplantation programs in the pandemic. Further policy making and preparedness is required to safeguard the most vulnerable areas of the world to minimize the impact of any future pandemic in transplantation practices.

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Section: Discussionmentioning

confidence: 99%

Global Impact of the COVID-19 Pandemic on Solid Organ Transplant

Kute

Tullius

Rane

et al. 2022

Transplantation Proceedings

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“…23 (14) 21 (14) 17 (16) Including death with failed allograft 278 (10) 20 (4) 54 (11) 49 (7) 58 (9) 97 ( 16)…”

Section: Discussionmentioning

confidence: 99%

“…Redefining the assessment of high-KDPI donors may avoid procurement in those with additional identified risk, or guide the selection of recipients and scenarios with more favorable summative risk profiles. 688 (24) 87 (18) 112 (22) 157 (23) 157 (25) 175 (28) 51 (27) 43 (25) 49 ( 312 27 (6) 47 (9) 53 (8) 52 (8) 71 (11) 21 (11) 15 (9) 20 (13) 15 (14) Failed allograft (%) 220 ( 8)…”

Section: Discussionmentioning

confidence: 99%

“…Although KDRI/KDPI algorithms are based on the cumulative risk of allograft failure, multiple authors have quantified the intuitive association between increasing KDPI and poorer allograft function. 5 , 8 Pruett et al 9 argue that failure to achieve sufficient function from transplantation (defined as estimated glomerular filtration rate [eGFR] >30 mL/min 1 y post-transplantation) may negate survival benefits to recipients over remaining on dialysis. Beyond this, impaired allograft function (1-y eGFR <30 mL/min) has been associated with other important recipient outcomes, including increased rates of hospitalization, post-transplant interventions, infection and cardiovascular morbidity and mortality.…”

Section: Introductionmentioning

confidence: 99%

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Beyond Graft Survivl: A National Cohort Study Quantifying the Impact of Increasing Kidney Donor Profile Index on Recipient Outcomes 1 Year Post-transplantation

Tully

Hayes

Hughes

et al. 2022

Transplantation Direct

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Kidney TransplantationBackground. The reporting of a locally validated kidney donor profile index (KDPI) began in Australia in 2016. Across diverse populations, KDPI has demonstrated utility in predicting allograft survival and function. A metric that incorporates both elements may provide a more comprehensive picture of suboptimal recipient outcomes. Methods. A retrospective cohort study of adult kidney transplant recipients in Australia (January 2009 to December 2014) was conducted. Conventional recipient outcomes and a composite measure of suboptimal outcome (1-y allograft failure or estimated glomerular filtration rate [eGFR] <30 mL/min) were evaluated across KDPI intervals (KDPI quintiles and 5-point increments in the KDPI 81-100 cohort). The impact of increasing KDPI on allograft function (1-y eGFR) and a suboptimal outcome was explored using multivariable regression models, adjusting for potential confounding factors. Results. In 2923 donor kidneys eligible for analysis, median KDPI was 54 (interquartile range [IQR], 31-77), and Kidney Donor Risk Index was 1.39 (IQR, 1.03-1.67). The median 1-y eGFR was 52.74 mL/min (IQR, 40.79-66.41 mL/min). Compared with the first quintile reference group, progressive reductions in eGFR were observed with increasing KDPI and were maximal in the fifth quintile (adjusted β-coefficient: −27.43 mL/min; 95% confidence interval, -29.44 to -25.42; P < 0.001). A suboptimal outcome was observed in 359 recipients (12.3%). The adjusted odds for this outcome increased across quintiles from a baseline of odds ratio of 1.00 (first quintile) to odds ratio of 11.68 (95% confidence interval, 6.33-21.54, P < 0.001) in the fifth quintile cohort. Conclusions. Increases in donor KDPI were associated with higher probabilities of a suboptimal outcome and poorer baseline allograft function, particularly in the KDPI > 80 cohort. These findings may inform pretransplant discussions with potential recipients of high-KDPI allografts.

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“…KDRI is an indicator that measures the risk of failure after a KTx. The parameter combines 10 donor-derived variables: age, height, weight, ethnicity/race, presence of HTN, DM, cause of death, sCr, HCV status, and donation after circulatory death [11,12]. KDPI stands for cumulative risk of kidney donor failure and allows one to effectively assess the risk of DGF; it is a good indicator of transplant and recipient survival, and it also discriminates against cardiac causes of death with cerebrovascular death [12,13].…”

Section: Data Collectionmentioning

confidence: 99%

Artificial Intelligence—A Tool for Risk Assessment of Delayed-Graft Function in Kidney Transplant

Konieczny

Stojanowski

Rydzyńska

et al. 2021

JCM

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Delayed-graft function (DGF) might be responsible for shorter graft survival. Therefore, a clinical tool predicting its occurrence is vital for the risk assessment of transplant outcomes. In a single-center study, we conducted data mining and machine learning experiments, resulting in DGF predictive models based on random forest classifiers (RF) and an artificial neural network called multi-layer perceptron (MLP). All designed models had four common input parameters, determining the best accuracy and discriminant ability: donor’s eGFR, recipient’s BMI, donor’s BMI, and recipient–donor weight difference. RF and MLP designs, using these parameters, achieved an accuracy of 84.38% and an area under curve (AUC) 0.84. The model additionally implementing a donor’s age, gender, and Kidney Donor Profile Index (KDPI) accomplished an accuracy of 93.75% and an AUC of 0.91. The other configuration with the estimated post-transplant survival (EPTS) and the kidney donor risk profile (KDRI) achieved an accuracy of 93.75% and an AUC of 0.92. Using machine learning, we were able to assess the risk of DGF in recipients after kidney transplant from a deceased donor. Our solution is scalable and can be improved during subsequent transplants. Based on the new data, the models can achieve better outcomes.

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US deceased kidney transplantation: Estimated GFR, donor age and KDPI association with graft survival

Cited by 9 publications

References 29 publications

Global Impact of the COVID-19 Pandemic on Solid Organ Transplant

Global Impact of the COVID-19 Pandemic on Solid Organ Transplant

Beyond Graft Survivl: A National Cohort Study Quantifying the Impact of Increasing Kidney Donor Profile Index on Recipient Outcomes 1 Year Post-transplantation

Artificial Intelligence—A Tool for Risk Assessment of Delayed-Graft Function in Kidney Transplant

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