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Kidney Donor Profile Index in a Transplant Center in Mexico
Aldo García-Covarrubias1, Jorge Morales1, Valeria Espinosa1
1Department of Organ Donation, Hospital General de Mexico Dr Eduardo Liceaga, Mexico City, México.
Background:
The Kidney Donor Profile Index (KDPI) was created in 2014 to measure the likelihood of graft failure for a given donor compared with the median kidney donor from the previous year. This scale is based on the American population only. Mexico is one of the countries with greater incidence of chronic kidney disease, a long waiting list, and not enough kidney donors with KDPI smaller than 80%. This has led transplant centers to take kidney grafts with a higher KDPI.
Objective:
To investigate the agreement between the KDPI and histologic scores (preimplantation renal biopsy) and assess the relationship between the Kidney Donor Risk Index (KDRI), KDPI, and the histologic score on graft survival.
Methods:
A retrospective, analytical, transversal study was performed. Data were collected from patients with kidney grafts from deceased donors from January 1, 2011, to June 30, 2019, at our hospital. The variables analyzed were age, weight, height, sex, race and/or ethnicity, history of hypertension or diabetes, cause of death, serum creatinine, KDPI, KDRI, and biopsy result from each graft prior to transplant.
Results:
The total population was 59 deceased kidney donors. For our patients, a high KDPI did not increase mortality rate; it provided greater benefit than staying on dialysis.
Conclusions:
We conclude that the use of KDRI should only be considered to assess the degree of fibrosis, not to rule out a transplantable kidney, in addition to the consistent demonstration that high KDPI kidneys (even 91%-100%) confer greater survival benefits to patients regarding the waiting list.
Insights
High Kidney Donor Profile Index (KDPI) kidneys offer survival benefits, even those with scores of 91%-100%. These findings suggest KDPI should not rule out transplants, especially for patients on dialysis waiting lists.
Area of Science:
- Nephrology
- Transplantation Immunology
- Public Health
Background:
- The Kidney Donor Profile Index (KDPI) estimates graft failure risk based on US donors.
- Mexico faces high chronic kidney disease rates and donor shortages, leading to the use of higher KDPI grafts.
- Transplant centers increasingly utilize higher KDPI kidneys due to donor scarcity.
Purpose of the Study:
- To evaluate the correlation between KDPI and histologic findings from preimplantation renal biopsies.
- To determine the relationship between KDRI, KDPI, and histologic scores in predicting graft survival.
Main Methods:
- Retrospective analysis of kidney grafts from deceased donors (Jan 2011 - Jun 2019).
- Collected data included donor demographics, medical history, KDPI, KDRI, and pre-transplant biopsy results.
- Analyzed variables such as age, weight, height, sex, comorbidities, cause of death, and serum creatinine.
Main Results:
- A total of 59 deceased kidney donors were included in the study.
- High KDPI did not correlate with increased mortality in the studied population.
- Utilizing higher KDPI grafts demonstrated a survival advantage over remaining on dialysis.
Conclusions:
- The Kidney Donor Risk Index (KDRI) is best used for assessing fibrosis, not for excluding kidneys from transplantation.
- Kidneys with high KDPI scores (91%-100%) provide significant survival benefits compared to dialysis.
- High KDPI kidneys should be considered for transplantation to improve patient outcomes and reduce waiting list times.
