Kidney Week

Abstract: SA-PO071

Ten-Year Analysis of Transplant Recipients of High KDPI Kidneys

Session Information

• Transplantation: Recipient and Donor Assessment
  October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Transplantation

• 1802 Transplantation: Clinical

Authors

• Comai, Giorgia, University of Bologna, Bologna, BO, Italy

Giorgia Comai,

• Cappuccilli, Maria, University of Bologna, Bologna, BO, Italy

Maria Cappuccilli,

• Angeletti, Andrea, University of Bologna, Bologna, BO, Italy

Andrea Angeletti,

• Corradetti, Valeria, University of Bologna, Bologna, BO, Italy

Valeria Corradetti,

• Cuna, Vania, University of Bologna, Bologna, BO, Italy

Vania Cuna,

• Baraldi, Olga, University of Bologna, Bologna, BO, Italy

Olga Baraldi,

• Conte, Diletta, University of Bologna, Bologna, BO, Italy

Diletta Conte,

• Donadei, Chiara, University of Bologna, Bologna, BO, Italy

Chiara Donadei,

• Ravaioli, Matteo, University of Bologna, Bologna, Italy

Matteo Ravaioli,

• La Manna, Gaetano, University of Bologna, Bologna, BO, Italy

Gaetano La Manna,

Background

The growing shortage of transplantable kidneys have pointed a great attention on the use of expanded criteria donors (ECDs). About 15% of deceased donor kidneys come from marginal donors, but there is some evidence to indicate that ECD recipients have poorer prognosis, higher incidence of DGF (31% vs 23%) and elevated risk of graft loss, up to 70%. However, the use of ECDs is an effort to increase the pool of organs available for transplant, reduce waiting times on transplant list and ensure optimal allocation of marginal kidneys in the elderly.
Kidney Donor Profile Index (KDPI) is a score, ranging from 0% to 100%, based on the quality of all kidneys recovered in the previous year, and estimates the potential function of a donated kidney. A donor KDPI>85% is assumed to be equivalent to an ECD kidney. UNOS data show that only 11% of kidneys from donors with KDPI>85% are used for transplant, and their 5-year survival approximates only 50%.

Methods

This is a retrospective analysis of KDPI in 246 adult kidney transplants (192 single, 54 double) from ECD donors between 2007 and 2016.
The mean recipient age was 60.2 years, donor age 67.4 years, KDPI 90.5%, cold ischemia time 14 h, total Karpinski score 3.9, glomerulosclerosis 0.4, interstitial fibrosis 0.9. tubular atrophy 0.6, IFTA 1.5, vascular score 1.1.

Results

Ten-year graft and patient survival were 76% and 80%, respectively (Fig. 1). The incidence of DGF was 44.7%, that of acute rejection 14.6%. GFR at discharge, at 1 year, at 5 years, and at 10 years were 41.5±21.8, 44.9±18.4, 49.5±20, and 53.4±27 mL/min, respectively.
Considering total Karpinski score or single histological lesions, no correlation was found with graft and patient survival, DGF and rejection rates. KDPI, donor age and recipient age were predictive of 1-year eGFR decline.

Conclusion

The high survival rates and the satisfying functional performance suggest a good medium-long term prognosis for renal transplant recipients of high KDPI kidneys considered as marginal according to the ECD classification.