Validation of KDRI/KDPI for the selection of expanded criteria kidney donors

Martín, Raimundo M García del Moral; Díaz, Juan Antonio Retamero; Molina, Mercedes; Tornel, Belen M. Cobacho; Soto, Juan Bravo; Ortega, Antonio Osuna; Ravassa, F OʼValle; Garrido, Raimundo García del Moral

doi:10.1016/j.nefroe.2017.12.003

Cited by 8 publications

(7 citation statements)

References 16 publications

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“…Third, the (L)KDPI in the investigated cohort correlated well with chronic lesions such as arteriosclerosis, glomerulosclerosis and IF/TA giving reason to expected lower graft quality of marginal donor kidneys, which was shown previously (34). This correlation was also observed in a study on pre-implantation biopsies (35). Kidney grafts can also be evaluated by pretransplant donor biopsies, but due to a high heterogeneity in biopsy-technique, histological evaluation, and study design no valuable recommendation can be derived to include pretransplant donor biopsies into daily routine (36).…”

Section: Discussionsupporting

confidence: 80%

The Kidney Donor Profile Index (KDPI) Correlates With Histopathologic Findings in Post-reperfusion Baseline Biopsies and Predicts Kidney Transplant Outcome

et al. 2022

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BackgroundThe increasing organ shortage in kidney transplantation leads to the necessity to use kidneys previously considered unsuitable for transplantation. Numerous studies illustrate the need for a better decision guidance rather than only the classification into kidneys from standard or expanded criteria donors referred to as SCD/ECD-classification. The kidney donor profile index (KDPI) exhibits a score utilizing a much higher number of donor characteristics. Moreover, graft biopsies provide an opportunity to assess organ quality.MethodsIn a single center analysis 383 kidney transplantations (277 after deceased and 106 after living donation) performed between January 1st, 2006, and December 31st, 2016, retrospectively underwent SCD/ECD and KDPI scoring. Thereby, the quality of deceased donor kidneys was assessed by using the KDPI and the living donor kidneys by using the living KDPI, in the further analysis merged as (L)KDPI. Baseline biopsies taken 10 min after the onset of reperfusion were reviewed for chronic and acute lesions. Survival analyses were performed using Kaplan-Meier analysis and Cox proportional hazards analysis within a 5-year follow-up.ResultsThe (L)KDPI correlated with glomerulosclerosis (r = 0.30, p < 0.001), arteriosclerosis (r = 0.33, p < 0.001), interstitial fibrosis, and tubular atrophy (r = 0.28, p < 0.001) as well as the extent of acute tubular injury (r = 0.20, p < 0.001). The C-statistic of the (L)KDPI concerning 5-year death censored graft survival was 0.692. Around 48% of ECD-kidneys were classified as (L)KDPI<85%. In a multivariate Cox proportional hazard analysis including (preformed) panel reactive antibodies, cold ischemia time, (L)KDPI, and SCD/ECD-classification, the (L)KDPI was significantly associated with risk of graft loss (hazard ratio per 10% increase in (L)KDPI: 1.185, 95% confidence interval: 1.033–1.360, p = 0.025). Survival analysis revealed decreased death censored (p < 0.001) and non-death censored (p < 0.001) graft survival in kidneys with an increasing (L)KDPI divided into groups of <35, 35–85, and >85%, respectively.ConclusionWith a higher granularity compared to the SCD/ECD-classification the (L)KDPI is a promising tool to judge graft quality. The correlation with chronic and acute histological lesions in post-reperfusion kidney biopsies underlines the descriptive value of the (L)KDPI. However, its prognostic value is limited and underlines the urgent need for a more precise prognostic tool adopted to European kidney transplant conditions.

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Section: Discussionsupporting

confidence: 80%

The Kidney Donor Profile Index (KDPI) Correlates With Histopathologic Findings in Post-reperfusion Baseline Biopsies and Predicts Kidney Transplant Outcome

et al. 2022

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“…A critic of this KDPI based rule is that a high KDPI in pediatric donors is because of low weight, height, and age but kidneys are histologic pristine, and as shown in this study hyperfiltration injury is of limited impact. This is in stark comparison to high KDPI adult kidneys, which often present some chronic kidney injury [23,24]. Considering the high thrombosis rate, one issue is the transplantation of SPD into pediatric recipients, where vascular anastomosis involving small-donor arteries may increase the risk of thrombosis [25].…”

Section: Discussionmentioning

confidence: 99%

Outcomes of small pediatric donor kidney transplants according to donor weight

et al. 2021

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A small pediatric deceased donor (SPD) weight cutoff whether to transplant as en bloc (EB) or single pediatric (SP) kidney is uncertain. Using UNOS/OPTN data (2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016)(2017)(2018)(2019), 27 875 SPDs were divided by (i) EB (11.4%) or SP (88.6%) and (ii) donor weight [≤10 (5.4%), >10-15 (8.3%), >15-18 (3.7%), >18-20 (2.9%), and >20 kg (79.7%)]. SP >20 kg and adult deceased donors (grouped by Kidney Donor Profile Index, KDPI, <30, 30-85, and >85) were used as references. The primary outcome was 10-year graft failure. In SP <10 kg, the hazard ratio (HR) for overall graft failure was 1.64 (1.38-2.20) compared with EB <10 kg, and 1.45 (1.18-1.80) compared with SP >20 kg. In SP >10-15 kg, HR was 1.31 (1.12-1.54) compared with EB >10-15 kg, and 1.04 (0.91-1.18) compared with SP >20 kg. In SP >15 kg, the risk was the same as SP >20 kg. Ten-year overall graft survival of SP 12 kg was comparable to SP >20 kg (62% vs. 57%). Tenyear death censored graft failure of SP >10-15 kg (70%) and SP >15-18 kg (70%) was like the adult donors with KDPI 30-85 (67%). In conclusion, we recommend single kidney transplants from SPDs with weight >12 kg to adult recipients in centers with experience in SPD transplants to optimize organ utilization.

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“…The second goal of KDRI introduction was to limit the percentage of discarded kidneys [ 13 ]. Nevertheless, in the USA and in some European countries the in-depth quality assessment of marginal kidneys is based mainly on the pre-implantation biopsy [ 7 , 14 , 15 ], the utility of which for predicting transplant outcomes is limited [ 16 , 17 ]. On the other hand, it has been suggested that chronic histological changes identified in early post-reperfusion biopsies better correlate with graft outcomes [ 18 , 19 ].…”

Section: Introductionmentioning

confidence: 99%

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

Słabiak-Błaż

Kujawa-Szewieczek

Kolonko

et al. 2023

Clinical Kidney Journal

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Background Proper assessment of donor organ quality is crucial for optimal kidney allocation and best long-term outcomes. The aim of this study was to analyze the association between the Kidney Donor Risk Index (KDRI) and histological parameters in early post-transplant graft biopsy in Polish cohort of kidney transplant recipients (KTRs). Methods In 418 consecutive KTRs, a histological evaluation of very early (at median 11 (9–13) post-transplant day) protocol core needle biopsy was performed and analyzed according to the Banff classification. Subjects were divided into quartiles (Q) of the KDRI value. Kidney graft function, patient and graft survival were also analyzed over a median follow-up period of 44 (26–56) months. Results There was a significant trend toward greater intensity of chronic histology changes along the KDRI quartiles (χ2 = 20.8; p < 0.001), including interstitial fibrosis, tubular atrophy, mesangial matrix increase and arteriolar hyalinosis. Stepwise multivariate regression analysis revealed that only higher KDRI value independently increased the severity of chronic graft injury (rpartial = 0.340, p < 0.001). KDRI values were valuable in the determination of both early and long-term graft function. Conclusion The KDRI values correlates with chronic histological changes found in early post-implantation kidney biopsies and can also be helpful in the prediction of graft outcome.

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Validation of KDRI/KDPI for the selection of expanded criteria kidney donors

Cited by 8 publications

References 16 publications

The Kidney Donor Profile Index (KDPI) Correlates With Histopathologic Findings in Post-reperfusion Baseline Biopsies and Predicts Kidney Transplant Outcome

The Kidney Donor Profile Index (KDPI) Correlates With Histopathologic Findings in Post-reperfusion Baseline Biopsies and Predicts Kidney Transplant Outcome

Outcomes of small pediatric donor kidney transplants according to donor weight

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

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