Beyond Graft Survivl: A National Cohort Study Quantifying the Impact of Increasing Kidney Donor Profile Index on Recipient Outcomes 1 Year Post-transplantation
Background. The reporting of a locally validated kidney donor profile index (KDPI) began in Australia in 2016. Across diverse populations, KDPI has demonstrated utility in predicting allograft survival and function. A metric that incorporates both elements may provide a more comprehensive picture of...
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer
2022-05-01
|
| Series: | Transplantation Direct |
| Online Access: | http://journals.lww.com/transplantationdirect/fulltext/10.1097/TXD.0000000000001308 |
| _version_ | 1818523622222856192 |
|---|---|
| author | Emma K. Tully, MBBS, BMedSci, FRACS Ian P. Hayes, MBBS, MS, MEp, FRACS, FRCS Peter D. Hughes, MBBS, FRACP, PhD Matthew P. Sypek, MBBS, FRACP, PhD |
| author_facet | Emma K. Tully, MBBS, BMedSci, FRACS Ian P. Hayes, MBBS, MS, MEp, FRACS, FRCS Peter D. Hughes, MBBS, FRACP, PhD Matthew P. Sypek, MBBS, FRACP, PhD |
| author_sort | Emma K. Tully, MBBS, BMedSci, FRACS |
| collection | DOAJ |
| description | Background. The reporting of a locally validated kidney donor profile index (KDPI) began in Australia in 2016. Across diverse populations, KDPI has demonstrated utility in predicting allograft survival and function. A metric that incorporates both elements may provide a more comprehensive picture of suboptimal recipient outcomes.
Methods. A retrospective cohort study of adult kidney transplant recipients in Australia (January 2009 to December 2014) was conducted. Conventional recipient outcomes and a composite measure of suboptimal outcome (1-y allograft failure or estimated glomerular filtration rate [eGFR] <30 mL/min) were evaluated across KDPI intervals (KDPI quintiles and 5-point increments in the KDPI 81–100 cohort). The impact of increasing KDPI on allograft function (1-y eGFR) and a suboptimal outcome was explored using multivariable regression models, adjusting for potential confounding factors.
Results. In 2923 donor kidneys eligible for analysis, median KDPI was 54 (interquartile range [IQR], 31–77), and Kidney Donor Risk Index was 1.39 (IQR, 1.03–1.67). The median 1-y eGFR was 52.74 mL/min (IQR, 40.79–66.41 mL/min). Compared with the first quintile reference group, progressive reductions in eGFR were observed with increasing KDPI and were maximal in the fifth quintile (adjusted β-coefficient: −27.43 mL/min; 95% confidence interval, –29.44 to –25.42; P < 0.001). A suboptimal outcome was observed in 359 recipients (12.3%). The adjusted odds for this outcome increased across quintiles from a baseline of odds ratio of 1.00 (first quintile) to odds ratio of 11.68 (95% confidence interval, 6.33-21.54, P < 0.001) in the fifth quintile cohort.
Conclusions. Increases in donor KDPI were associated with higher probabilities of a suboptimal outcome and poorer baseline allograft function, particularly in the KDPI > 80 cohort. These findings may inform pretransplant discussions with potential recipients of high-KDPI allografts. |
| first_indexed | 2024-12-11T05:47:08Z |
| format | Article |
| id | doaj.art-cb3f578f96444ccca2aafd6f4ea9f5d7 |
| institution | Directory Open Access Journal |
| issn | 2373-8731 |
| language | English |
| last_indexed | 2024-12-11T05:47:08Z |
| publishDate | 2022-05-01 |
| publisher | Wolters Kluwer |
| record_format | Article |
| series | Transplantation Direct |
| spelling | doaj.art-cb3f578f96444ccca2aafd6f4ea9f5d72022-12-22T01:18:56ZengWolters KluwerTransplantation Direct2373-87312022-05-0185e130810.1097/TXD.0000000000001308202205000-00013Beyond Graft Survivl: A National Cohort Study Quantifying the Impact of Increasing Kidney Donor Profile Index on Recipient Outcomes 1 Year Post-transplantationEmma K. Tully, MBBS, BMedSci, FRACS0Ian P. Hayes, MBBS, MS, MEp, FRACS, FRCS1Peter D. Hughes, MBBS, FRACP, PhD2Matthew P. Sypek, MBBS, FRACP, PhD31 Department of General Surgical Specialties, The Royal Melbourne Hospital, Parkville, VIC, Australia.1 Department of General Surgical Specialties, The Royal Melbourne Hospital, Parkville, VIC, Australia.2 Department of Nephrology, The Royal Melbourne Hospital, Parkville, VIC Australia.2 Department of Nephrology, The Royal Melbourne Hospital, Parkville, VIC Australia.Background. The reporting of a locally validated kidney donor profile index (KDPI) began in Australia in 2016. Across diverse populations, KDPI has demonstrated utility in predicting allograft survival and function. A metric that incorporates both elements may provide a more comprehensive picture of suboptimal recipient outcomes. Methods. A retrospective cohort study of adult kidney transplant recipients in Australia (January 2009 to December 2014) was conducted. Conventional recipient outcomes and a composite measure of suboptimal outcome (1-y allograft failure or estimated glomerular filtration rate [eGFR] <30 mL/min) were evaluated across KDPI intervals (KDPI quintiles and 5-point increments in the KDPI 81–100 cohort). The impact of increasing KDPI on allograft function (1-y eGFR) and a suboptimal outcome was explored using multivariable regression models, adjusting for potential confounding factors. Results. In 2923 donor kidneys eligible for analysis, median KDPI was 54 (interquartile range [IQR], 31–77), and Kidney Donor Risk Index was 1.39 (IQR, 1.03–1.67). The median 1-y eGFR was 52.74 mL/min (IQR, 40.79–66.41 mL/min). Compared with the first quintile reference group, progressive reductions in eGFR were observed with increasing KDPI and were maximal in the fifth quintile (adjusted β-coefficient: −27.43 mL/min; 95% confidence interval, –29.44 to –25.42; P < 0.001). A suboptimal outcome was observed in 359 recipients (12.3%). The adjusted odds for this outcome increased across quintiles from a baseline of odds ratio of 1.00 (first quintile) to odds ratio of 11.68 (95% confidence interval, 6.33-21.54, P < 0.001) in the fifth quintile cohort. Conclusions. Increases in donor KDPI were associated with higher probabilities of a suboptimal outcome and poorer baseline allograft function, particularly in the KDPI > 80 cohort. These findings may inform pretransplant discussions with potential recipients of high-KDPI allografts.http://journals.lww.com/transplantationdirect/fulltext/10.1097/TXD.0000000000001308 |
| spellingShingle | Emma K. Tully, MBBS, BMedSci, FRACS Ian P. Hayes, MBBS, MS, MEp, FRACS, FRCS Peter D. Hughes, MBBS, FRACP, PhD Matthew P. Sypek, MBBS, FRACP, PhD Beyond Graft Survivl: A National Cohort Study Quantifying the Impact of Increasing Kidney Donor Profile Index on Recipient Outcomes 1 Year Post-transplantation Transplantation Direct |
| title | Beyond Graft Survivl: A National Cohort Study Quantifying the Impact of Increasing Kidney Donor Profile Index on Recipient Outcomes 1 Year Post-transplantation |
| title_full | Beyond Graft Survivl: A National Cohort Study Quantifying the Impact of Increasing Kidney Donor Profile Index on Recipient Outcomes 1 Year Post-transplantation |
| title_fullStr | Beyond Graft Survivl: A National Cohort Study Quantifying the Impact of Increasing Kidney Donor Profile Index on Recipient Outcomes 1 Year Post-transplantation |
| title_full_unstemmed | Beyond Graft Survivl: A National Cohort Study Quantifying the Impact of Increasing Kidney Donor Profile Index on Recipient Outcomes 1 Year Post-transplantation |
| title_short | Beyond Graft Survivl: A National Cohort Study Quantifying the Impact of Increasing Kidney Donor Profile Index on Recipient Outcomes 1 Year Post-transplantation |
| title_sort | beyond graft survivl a national cohort study quantifying the impact of increasing kidney donor profile index on recipient outcomes 1 year post transplantation |
| url | http://journals.lww.com/transplantationdirect/fulltext/10.1097/TXD.0000000000001308 |
| work_keys_str_mv | AT emmaktullymbbsbmedscifracs beyondgraftsurvivlanationalcohortstudyquantifyingtheimpactofincreasingkidneydonorprofileindexonrecipientoutcomes1yearposttransplantation AT ianphayesmbbsmsmepfracsfrcs beyondgraftsurvivlanationalcohortstudyquantifyingtheimpactofincreasingkidneydonorprofileindexonrecipientoutcomes1yearposttransplantation AT peterdhughesmbbsfracpphd beyondgraftsurvivlanationalcohortstudyquantifyingtheimpactofincreasingkidneydonorprofileindexonrecipientoutcomes1yearposttransplantation AT matthewpsypekmbbsfracpphd beyondgraftsurvivlanationalcohortstudyquantifyingtheimpactofincreasingkidneydonorprofileindexonrecipientoutcomes1yearposttransplantation |