Aguilar-Frasco JL, Arreola-Guerra JM, Paláu-Dávila L, Visag V, Vilatobá-Chapa M, Contreras-Saldivar A, Sanchez A, Alberú-Gómez J

Language: English
References: 6
Page: 47-51
PDF size: 221.01 Kb.

ABSTRACT

Several scoring systems have been proposed to evaluate the quality of kidneys from deceased donors (DD). Recently, kidney donor risk index (KDRI) was introduced in the USA as a refined version of the dichotomous extended criteria donor (ECD) score versus non-ECD. Objective: To evaluate the usefulness of the KDRI as a tool risk predictor of graft loss, delayed graft function and clinical outcomes at one year post-transplant in patients with deceased donor kidney transplantation (DDKT) in our center. Material and methods: 96 patients transplanted from Jan/2008 to Nov/2013 with deceased kidney donors were included. DD were on average 41.2 (± 12.6) years old and 49 (51%) were female. The donors had an average KDRI of 0.86 (ratio 0.58~ 1.55). The information for this retrospective cohort study came from the data base of DD kidney transplants at our center. All patients included had at least one year of clinical follow-up. Univariate and multivariate analysis were performed using linear regression adjusted to diverse variables such as, immunological risk, acute rejection and delayed graft function. Results: The mean KDRI was 0.86 (range, 0.58~1.55). More than 75% of donors had KDRI ‹ 1.0. The KDRI were divided into three groups: 0.5-0.74, 0.75-0.99 and ≥ 1.0. The incidence of DGF was significantly more frequent in the group with KDRI ≥1.0 (30%) than KDRI ‹ 0.74 (1%), p ≤ 0.01, and higher KDRI was associated with increased episodes of acute rejection and graft loss. Graft function was significantly lower in those with KDRI ≥ 1.0 (p ‹ 0.01). One-year graft survival in the KDRI groups was 100%, 92.3% and 80%, respectively. Conclusions: The KDRI discriminated accordingly and in a significant manner patients with DGF and correlated with renal function from one month to one year follow up. The correlation between the KDRI and the GFR was persistent and significant during the follow-up. KDRI is a useful prognostic tool for evaluation of graft function during the first year post-transplant.

REFERENCES

1. Port FK, Bragg-Gresham JL, Metzger RA, Dykstra DM, Gillespie BW, Young EW et al. Donor characteristics associated with reduced graft survival: An approach to expanding the pool of kidney donors. Transplantation. 2002; 74 (9): 1281-1286.

2. Port FK, Dykstra DM, Merion RM, Wolfe RA. Trends and results for organ donation and transplantation in the United States, 2004. Am J Transplant. 2005; 5 (4 Pt 2): 843-849.

3. Rao PS, Schaubel DE, Guidinger MK, Andreoni KA, Wolfe RA, Merion RM et al. A comprehensive risk quantification score for deceased donor kidneys: the kidney donor risk index. Transplantation. 2009; 88 (2): 231-236.

4. Heaphy EL, Goldfarb DA, Poggio ED, Buccini LD, Flechner SM, Schold JD. The impact of deceased donor kidney risk significantly varies by recipient characteristics. American Journal of Transplantation. 2013; 13 (4): 1001-1011.

5. OPTN KDPI/KDRI Calculator. [Accessed June 20 of 2012] Available in: http://optn.transplant.hrsa.gov/resources/allocationcalculators.asp?index=81.

6. Lee AP, Abramowicz D. Is the Kidney donor risk index a step forward in the assessment of deceased donor kidney quality? Nephrol Dial Transplant. 2014; 30 (8): 1285-1290.