KDPI Score: A Comparison with Classical ECD/SCD Classification in Predicting Outcomes

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Abstract

Background

Kidney donor shortage requires an expansion in selection criteria and objective tools to minimize discarded organs. Easy donor pretransplant variables such as age, standard/expanded criteria donors (SCD/ECD) and Kidney Donor Profile Index (KDPI), have demonstrated correlations with patient and graft outcomes. We aimed to establish the accuracy of the three models to determine the prognostic value on kidney transplantation (KT) major outcomes.

Methods

Retrospective study in deceased donor KT at our institution. Unadjusted Cox and Kaplan-Meier survival, and multivariate Cox analysis were fitted to analyze the impact of the three predictor scores donor age, SCD/ECD and KDPI on outcomes.

Results

389 KT included. Donor age 53.6±15.2y; 41.9% ECD; mean KDPI 69.4±23.4%. Median follow-up 51.9m. Unadjusted Cox and Kaplan-Meier showed that the three prognostic variables (donor age, ECD status and KDPI) were related with increased risk of patient death, graft failure and death-censored graft failure. However, in the multivariate analysis only KDPI was related with higher risk of graft failure (HR 1.03 each 1% [1.01-1.05]; p=0.014). Multivariate models for graft failure were calculated including donor age as a continuous variable, donor age >60y, ECD definition, KDPI (continuous variable) or different KDPI cut-offs.

Conclusions

SCD/ECD classification did not provide significant prognostic outcome information. KDPI was linearly related with higher risk of graft failure, providing a better assessment. More studies are needed before using KDPI as a tool to discard or accept kidneys for transplantation.

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