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Published on: June 21, 2024
Utility of Applying Quality Assessment Tools for Kidneys With KDPI ≥80
Mona D Doshi1, Peter P Reese, Isaac E Hall
11 Division of Nephrology, Department of Medicine, Wayne State University School of Medicine, Detroit, MI. 2 Renal-Electrolyte and Hypertension Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA. 3 Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA. 4 Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA. 5 Division of Nephrology, Hypertension & Renal Transplantation, Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT. 6 Section of Nephrology, University Hospital, Ulm, Germany. 7 Program of Applied Translational Research, Department of Medicine, Yale University School of Medicine, New Haven, CT. 8 Section of Nephrology, Yale University School of Medicine, New Haven, CT. 9 Saint Barnabas Medical Center, Livingston, NJ. 10 Gift of Life Institute, Philadelphia, PA. 11 Veterans Affairs Connecticut Healthcare System, New Haven, CT.
Insights
High Kidney Donor Profile Index (KDPI) kidneys are often discarded. This study found some discarded high KDPI kidneys are viable, but current biomarkers are insufficient for assessment.
Area of Science:
- Nephrology
- Transplant Surgery
- Organ Donation
Background:
- Kidneys with high Kidney Donor Profile Index (KDPI) are frequently biopsied, pumped, and discarded.
- Understanding the characteristics and outcomes of these kidneys is crucial for optimizing organ utilization.
Purpose of the Study:
- To characterize deceased donor kidneys with a KDPI of 80 or greater.
- To evaluate outcomes associated with discarding or transplanting these high KDPI kidneys.
- To assess the utility of current biomarkers in determining kidney viability.
Main Methods:
- A multicenter study of 338 deceased donors, excluding those with anatomical kidney abnormalities.
- Donors categorized based on kidney discard status: none, one discarded/one transplanted, or both discarded.
- Analysis of donor demographics, terminal creatinine, KDPI, biopsy findings, renal resistance, and kidney injury biomarkers.
Main Results:
- Donors with both kidneys discarded were older, more often white, and had higher creatinine and KDPI.
- Biopsy and pumping were common; discard was linked to biopsy findings and renal resistance.
- Kidney injury biomarker levels did not differ significantly between groups.
- No significant difference in 1-year graft function or failure between non-discarded and single-discarded kidney groups.
Conclusions:
- Kidneys with KDPI ≥ 80 represent a significant, resource-intensive portion of the donor pool with high discard rates.
- Data suggest some discarded high KDPI kidneys are viable, but current assessment tools and biomarkers are inadequate.
- Improved methods are needed to accurately assess the viability of kidneys with high KDPI to reduce unnecessary discard.
Background:
Kidneys with "high" Kidney Donor Profile Index (KDPI) are often biopsied and pumped, yet frequently discarded.
Methods:
In this multicenter study, we describe the characteristics and outcomes of kidneys with KDPI of 80 or greater that were procured from 338 deceased donors. We excluded donors with anatomical kidney abnormalities.
Results:
Donors were categorized by the number of kidneys discarded: (1) none (n = 154, 46%), (2) 1 discarded and 1 transplanted (n = 48, 14%), (3) both discarded (n = 136, 40%). Donors in group 3 were older, more often white, and had higher terminal creatinine and KDPI than group 1 (all P < 0.05). Biopsy was performed in 92% of all kidneys, and 47% were pumped. Discard was associated with biopsy findings and first hour renal resistance. Kidney injury biomarker levels (neutrophil gelatinase-associated lipocalin, IL-18, and kidney injury molecule-1 measured from donor urine at procurement and from perfusate soon after pump perfusion) were not different between groups. There was no significant difference in 1-year estimated glomerular filtration rate or graft failure between groups 1 and 2 (41.5 ± 18 vs 41.4 ± 22 mL/min per 1.73 m; P = 0.97 and 9% vs 10%; P = 0.76).
Conclusions:
Kidneys with KDPI of 80 or greater comprise the most resource consuming fraction of our donor kidney pool and have the highest rates of discard. Our data suggest that some discarded kidneys with KDPI of 80 or greater are viable; however, current tools and urine and perfusate biomarkers to identify these viable kidneys are not satisfactory. We need better methods to assess viability of kidneys with high KDPI.
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