Impact of Kidney Donor Profile Index Scores on Post-Transplant Clinical Outcomes Between Elderly and Young Recipients, A Multicenter Cohort Study

Abstract

We investigated if clinical outcomes after kidney transplantation (KT) from deceased donors (DDs) with high Kidney Donor Profile Index (KDPI) can be different according to the age of KT recipients (KTRs). Six-hundred fifty-seven KTRs from 526 DDs were included from four transplant centers. We divided KTRs into elderly-KTR and young-KTR groups based on age 60 and each group was subdivided into high-or low-KDPI subgroup based on KDPI score of 65%. We compared short-term and long-term clinical outcomes among those four subgroups (low KDPI-young KTR, low KDPI-elderly-KTR, high KDPI-young-KTR, high KDPI-elderly-KTR). In short-term outcomes including acute rejection, BK virus and CMV infection, there was no significant difference among the four subgroups. In the long-term outcomes, the development of cardiovascular disease was higher in the high KDPI-elderly-KTR group than the other groups. In comparison of allograft survival rate, the high KDPI-young KTR subgroup showed highest risk for allograft failure and there was significant interaction between high-KDPI donors and young-KTR on allograft survival rate (P = 0.002). However, there was no significant difference in comparison of the patient survival rate. In conclusion, clinical impact of high-KDPI in DDs on posttransplant allograft survival may be less significant in elderly-KTR than in young-KTR. The number of elderly patients with end-stage renal disease (ESRD) has increased globally parallel to the increases in mean life expectancy over the past several decades 1,2. According to the Korean ESRD Registry data, only 8% of the total number of ESRD patients were older than age 60 in 2004, which increased rapidly to 43.9% in 2016. Accordingly, the proportion of elderly patients undergoing kidney transplantation (KT) showed an almost six-fold increase, from 2% in 2000 to 11.6% in 2016 3. In terms of clinical outcomes, KT offers a better quality of life, cardiovascular stability, and improved survival compared to peritoneal dialysis (PD) or hemodialysis (HD) in

A Comorbidity Index and Pretransplant Physical Status Predict Survival in Older Kidney Transplant Recipients: A National Prospective Study

“…6,7 Current allocation policies attempt to match recipient and graft survival by directing expanded criteria donor organs (ECD) to older recipients. Compared with organs from standard criteria donors, ECD kidneys are associated with impaired survival outcomes 8,9 but with increased life expectancy over dialysis in older recipients [10][11][12] ; however, less than two thirds of patients older than 65 y are willing to undergo transplantation with ECD kidneys, resulting in a high discard rate of this useful source. 13 Although many older individuals are suitable and should be offered a transplant, they are not routinely referred to KT, and their chance of actually receiving a transplant is low.…”

Benchmark Outcomes in Deceased Donor Kidney Transplantation: A Multicenter Analysis of 80 996 Transplants From 126 Centers

“…Regarding deceased donor graft quality, we only included transplants performed from donors with a low KDPI, as high KDPI correlates negatively with graft survival. [28][29][30] Furthermore, only cases with a CIT ≤18 h were chosen because longer times have a detrimental impact on graft outcomes. 31 KT performed with an HLA mismatch >4 was excluded because 5 and 6 donor-recipient HLA mismatch have a kidney graft failure hazard ratio ≥1.5.…”

Association between Kidney Donor Risk Index, kidney graft function and histological changes in early post-transplant graft biopsy

“…In a recent study, Park et al . [ 32 ] examined the impact of KDRI on post-transplant clinical outcomes between elderly and young recipients, and revealed that the high KDRI-young recipients group has worse allograft outcome than the three other groups (i.e. low KDRI-young recipients, low KDRI-elderly recipients and high KDRI-elderly recipients).…”