Kidney Donor Profile Index and allograft outcomes: interactive effects of estimated post-transplant survival score and ischaemic time

Janelle Prunster; Germaine Wong; Nicholas Larkins; Kate Wyburn; Ross Francis; William R Mulley; Esther Ooi; Helen Pilmore; Christopher E Davies; Wai H Lim

doi:10.1093/ckj/sfac243

Kidney Donor Profile Index and allograft outcomes: interactive effects of estimated post-transplant survival score and ischaemic time

Clin Kidney J. 2022 Oct 31;16(3):473-483. doi: 10.1093/ckj/sfac243. eCollection 2023 Mar.

Authors

Janelle Prunster¹, Germaine Wong^{2

3

4}, Nicholas Larkins^{5

6}, Kate Wyburn^{7

8}, Ross Francis^{9

10}, William R Mulley^{11

12}, Esther Ooi^{13

14}, Helen Pilmore^{15

16}, Christopher E Davies^{17

18}, Wai H Lim^{1

19}

Affiliations

¹ Department of Renal Medicine, Sir Charles Gairdner Hospital, Nedlands, WA, Australia.
² School of Public Health, Faculty of Medicine and Health, Sydney University, Sydney, NSW, Australia.
³ Centre for Kidney Research, Children's Hospital at Westmead, Sydney, NSW, Australia.
⁴ Department of Renal Medicine and National Pancreas Transplant Unit, Westmead Hospital, Sydney, NSW, Australia.
⁵ Department of Nephrology, Perth Children's Hospital, Perth, WA, Australia.
⁶ School of Paediatrics and Child Health, University of Western Australia, Perth, WA, Australia.
⁷ Department of Renal Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
⁸ Charles Perkins Centre Kidney Node, University of Sydney, Sydney, NSW, Australia.
⁹ Department of Renal Medicine, Princess Alexandra Hospital, Brisbane, QLD, Australia.
¹⁰ Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia.
¹¹ Department of Nephrology, Monash Medical Centre, Melbourne, VIC, Australia.
¹² Department of Medicine, Monash University, Melbourne, VIC, Australia.
¹³ Medical School, University of Western Australia, Perth, WA, Australia.
¹⁴ School of Biomedical Sciences, University of Western Australia, Perth, WA, Australia.
¹⁵ Department of Renal Medicine, Auckland City Hospital, Auckland, New Zealand.
¹⁶ Department of Medicine, University of Auckland, Auckland, New Zealand.
¹⁷ Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia.
¹⁸ Australia and New Zealand Dialysis and Transplant Registry, South Australian Health and Medical Research Institute, Adelaide, SA, Australia.
¹⁹ Internal Medicine, University of Western Australia Medical School, Perth, WA, Australia.

Abstract

Background: The Kidney Donor Profile Index (KDPI) is routinely reported by the donation agencies in Australia. We determined the association between KDPI and short-term allograft loss and assessed if this association was modified by the estimated post-transplant survival (EPTS) score and total ischaemic time.

Methods: Using data from the Australia and New Zealand Dialysis and Transplant Registry, the association between KDPI (in quartiles) and 3-year overall allograft loss was examined using adjusted Cox regression analysis. The interactive effects between KDPI, EPTS score and total ischaemic time on allograft loss were assessed.

Results: Of 4006 deceased donor kidney transplant recipients transplanted between 2010 and 2015, 451 (11%) recipients experienced allograft loss within 3 years post-transplant. Compared with recipients of kidneys with a KDPI of 0-25%, recipients who received donor kidneys with a KDPI >75% experienced a 2-fold increased risk of 3-year allograft loss {adjusted hazard ratio [HR] 2.04 [95% confidence interval (CI) 1.53-2.71]}. The adjusted HRs for kidneys with a KDPI of 26-50% and 51-75% were 1.27 (95% CI 0.94-1.71) and 1.31 (95% CI 0.96-1.77), respectively. There were significant interactions between KDPI and EPTS scores (P-value for interaction <.01) and total ischaemic time (P-value for interaction <.01) such that the associations between higher KDPI quartiles and 3-year allograft loss were strongest in recipients with the lowest EPTS scores and longest total ischaemic time.

Conclusion: Recipients with higher post-transplant expected survival and transplants with longer total ischaemia who received donor allografts with higher KDPI scores experienced a greater risk of short-term allograft loss compared with those recipients with reduced post-transplant expected survival and with shorter total ischemia.

Keywords: EPTS; KDPI; allograft loss; donor quality; kidney transplant.