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Acta Chirurgica Latviensis

The Journal of Riga Stradins University; Latvian Association of Surgeons; Latvian Association of Paediatric Surgeons

2 Issues per year

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Online
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2199-5737
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Kidney Donor Profile Index in the Case of Repeated Transplantation

Klinta Gritane / Janis Jusinkis / Aleksandrs Malcevs / Vadims Suhorukovs / Diana Amerika / Ieva Ziedina
Published Online: 2018-09-25 | DOI: https://doi.org/10.1515/chilat-2017-0019

Abstract

Introduction. In 2014, new scoring system - Kidney Donor Profile Index (KDPI) was introduced. KDPI is a numerical measure that combines ten donor factors, including clinical parameters and demographics, to summarize into a single number the quality of deceased donor kidneys. There are some publications regarding usefulness of KDPI in the first kidney transplant recipients, however there are no data focusing on repeated transplantation patients. Aim of the Study. To determine the usefulness of kidney donor profile index as a risk marker of graft failure in repeated transplantation situations. Material and methods. A single-centre retrospective study was conducted. Patients who underwent a repeated transplantation from deceased donors between 2005. and 2013. were included in the study. Data about donor’s risk factors - age, height, weight, race, history of hypertension, history of diabetes, cause of death, serum creatinine, anti-HCV and if donor is after cardiac death - were collected and KDPI was calculated for all participants. Patients were divided into groups according to determined KDPI: Group 1 - KDPI <35%; Group 2 - KDPI 36 - 69%; Group 3 - KDPI >70%. For statistical analysis, IBM Statistical Package for the Social Sciences, version 21.0 was used. Results. A total of 72 patients were enrolled in the study. There were 17 patients (23.6%) in the 1. group, 38 patients (52.8%) in the 2. group and 17 patients (23.6%) in the 3. group. The most common cause of an end stage renal disease was chronic glomerulonephritis- 59.7% (n=43). Patients with higher KDPI developed acute rejection more often. In the group with KDPI <35% it was observed in 35.3%, while in the groups with KDPI 36 - 69% and KDPI >70% in 60.5% and 64.7% of patients, p = 0.02. Graft function differed significantly both, after one (p =0.01) and three years (p=0.04) with the highest eGFR results in the group with the lowest KDPI. The difference in graft survival rates was statistically significant, p = 0.027. After three- years it was 88.2% in the first group, 86.8% in the second group and 70.6% in the third group. Patient survival rates showed trend toward significance (p = 0.076) with only two patients lost during three- year follow up. Conclusions. KDPI presents relevance with repeated transplantation outcomes. Lower KDPI indicates better transplantation outcomes - superior graft function and better graft survival. However, there is only trend towards significance in patient survival rates.

Keywords: kidney; KDPI; outcomes; transplantation

References

  • 1. A Guide to Calculating and Interpreting the Kidney Donor Profile Index (KDPI). Available: https://optn.transplant.hrsa.gov/media/1512/guide_to_calculating_interpreting_kdpi.pdfGoogle Scholar

  • 2. Darren E, Stewart DK, Klassen. Early Experience with the New Kidney Allocation System: A Perspective from UNOS //Clin. J. Am. Soc. Nephrol, 2017; 12: 2063-2065Google Scholar

  • 3. Doshi MD, Reese PP, Hall IE et al. Utility of Applying Quality Assessment Tools for Kidneys With KDPI ≥80 //Transplant, 2017; 101(6): 1125-1133Google Scholar

  • 4. Filiopoulos V, Boletis JN. Renal transplantation with expanded criteria donors: Which is the optimal immunosuppression? //World J Transplant, 2016; 6(1):103-114Google Scholar

  • 5. Gupta A, Francos G, Frank AM et al. KDPI score is a strong predictor of future graft function: moderate KDPI (35-85) and high KDPI (>85) grafts yield similar graft function and survival //Clin Nephrol, 2016;86(10):175-182Google Scholar

  • 6. Hricik D. E., Halbert R. J., Barr M. L., et al. Life satisfaction in renal transplant recipients: preliminary results from the transplant learning center //Am J Kidney Dis, 2001; 38(3):580-587Google Scholar

  • 7. Jay CL, Washburn K, Dean PG Survival Benefit in Older Patients Associated With Earlier Transplant With High KDPI Kidneys //Transplantation, 2017; 101(4):867-872Google Scholar

  • 8. Kaplan B., Meier-Kriesche H.-U. Death after graft loss: an important late study endpoint in kidney transplantation //Am J Transplant, 2002; 2(10):970-974Google Scholar

  • 9. Marinaki S., Skalioti C., Boletis J. Patients after kidney allograft failure: immunologic and nonimmunologic considerations //Transplant Proc, 2015; 47(9):2677-82Google Scholar

  • 10. Matas AJ, Smith JM, Skeans MA, et al. OPTN/ SRTR 2013 annual data report: kidney //Am J Transplant. 2015; 15:1-34Google Scholar

  • 11. Nazarian SM, Peng AW, Duggirala B, et al. The kidney allocation system does not appropriately stratify risk of pediatric donor kidneys: Implications for pediatric recipients //Am J Transplant, 2018; 18(3): 574-579Google Scholar

  • 12. Oniscu G. C., Brown H., Forsythe J. L. R. Impact of cadaveric renal transplantation on survival in patients listed for transplantation //Journal of the Am Soc Nephrol, 2005; 16(6):1859-1865Google Scholar

  • 13. Parker WF, Thistlethwaite JR, Ross LF. Kidney Donor Profile Index (KDPI) Does Not Accurately Predict the Graft Survival of Pediatric Deceased Donor Kidneys //Transplant, 2016; 100 (11): 2471-2478Google Scholar

  • 14. Philipse E, Alison PK, Bracke LB, et al. Does Kidney Donor Risk Index implementation lead to the transplantation of more and higher-quality donor kidneys? //Nephrol Dial Transplant, 2017; 32 (11): 1934-1938Google Scholar

  • 15. Rege A, Irish B, Castleberry A, et al. Trends in Usage and Outcomes for Expanded Criteria Donor Kidney Transplantation in the United States Characterized by Kidney Donor Profile Index // Cureus, 2016;8(11):e887Google Scholar

  • 16. Sayin B, Colak T, Tutal E, Sezer S, Comparison of preemptive kidney transplant recipients with nonpreemptive kidney recipients in single center: 5 years of follow- up //Int J Nephrol Renovasc Dis, 2013; 6:95-99Google Scholar

  • 17. Szabo R. P, Klenk N, Balla J, et al. Prognosis of dialysed patients after kidney transplant failure // Kidney & Blood pressure Research, 2013; 37: 151-157.Google Scholar

About the article

Published Online: 2018-09-25

Published in Print: 2017-12-20


Citation Information: Acta Chirurgica Latviensis, Volume 17, Issue 2, Pages 21–24, ISSN (Online) 2199-5737, DOI: https://doi.org/10.1515/chilat-2017-0019.

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© 2018 Klinta Gritane, published by Sciendo. This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License. BY-NC-ND 4.0

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