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Related Concept Videos

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The kidneys are two large bean-shaped organs located in the upper abdomen. They filter the blood several times a day to remove toxins and rebalance water and electrolytes of the circulatory system via the renal veins. The kidneys receive blood directly from the heart via the renal arteries. These arteries enter the kidney at the hilum, the concave surface of the bean, where they branch and divide into smaller vessels and capillaries.
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A kidney transplant is a surgical approach that involves replacing a non-functioning kidney with a healthy one from a donor. This procedure is often a treatment option for end-stage renal disease (ESRD) patients. The method requires careful recipient selection, including evaluating various medical and psychosocial factors. These criteria vary between transplant centers but generally include assessments of the patient's overall health, adherence to medical recommendations, and lifestyle...
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Accurate diagnosis and effective prevention are critical in managing Acute Kidney Injury (AKI), which is linked to high mortality rates ranging from 10% to 80%. Timely recognition of at-risk patients and careful monitoring can significantly reduce the likelihood of kidney damage.Diagnostic Assessments:The diagnostic process starts with a comprehensive medical history to identify prerenal, intrarenal, and postrenal causes.Prerenal causes, such as dehydration, hypotension, or blood loss, should...
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Chronic Kidney Disease (CKD) arises when the kidneys progressively lose their ability to function, ultimately leading to end-stage renal disease. At this advanced stage, the kidneys can no longer filter waste or maintain essential body functions, requiring renal replacement therapy (RRT) through dialysis or a kidney transplant for survival.Early-stage chronic kidney disease and detection challengesIn CKD's early stages, symptoms often remain absent because healthy nephrons compensate for...
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"Rethinking High-KDPI Kidneys: A Multidomain Approach to Predicting Success".

Xingyu Zhang1, Chethan Puttarajappa2, Frank Spitz3

  • 1Biostatistics and Epidemiology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.

Clinical Transplantation
|February 4, 2026
PubMed
Summary
This summary is machine-generated.

High-KDPI kidney transplants have outcomes influenced by donor risk and recipient factors. Individualized assessment at offer time can improve kidney transplant utilization and patient outcomes.

Keywords:
high‐kdpikidney donor profile index (kdpi)kidney transplantpost‐transplant outcomesrisk prediction

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Area of Science:

  • Nephrology
  • Transplantation immunology
  • Public health

Background:

  • Kidney Donor Profile Index (KDPI) influences deceased-donor kidney allocation in the US.
  • Analysis of high-KDPI kidney transplants (2014-2021) identified predictors of post-transplant outcomes.
  • Study aimed to find predictors beyond KDPI for high-KDPI kidney transplants.

Purpose of the Study:

  • Identify key predictors of post-transplant outcomes for high-KDPI kidney transplants.
  • Determine factors influencing delayed graft function (DGF) and primary graft nonfunction (PGNF).
  • Analyze predictors of patient survival, graft survival, and death-censored graft survival.

Main Methods:

  • Retrospective cohort study using Scientific Registry of Transplant Recipients (SRTR) data.
  • Included adult, first-time recipients of kidney-only deceased-donor transplants with KDPI > 85%.
  • Regression models identified independent predictors of graft function and survival outcomes.

Main Results:

  • Delayed graft function (DGF) occurred in 33.8%, primary graft nonfunction (PGNF) in 4.0%.
  • DGF predictors: donation after circulatory death, high donor creatinine, recipient obesity, prolonged dialysis, long cold ischemia time (CIT); machine perfusion was protective.
  • PGNF predictors: donation after circulatory death, very high donor creatinine, high-risk CMV serostatus, donor injury patterns. Five-year patient/graft survival: 72%/62%.
  • Graft loss associated with DGF, elevated intrarenal resistive index (RI), recipient diabetes, prolonged dialysis, high-risk CMV/EBV serostatus.

Conclusions:

  • Post-transplant outcomes for high-KDPI kidneys depend on KDPI donor risk and recipient, immunologic, and perioperative factors.
  • A comprehensive, offer-time assessment can enhance individualized acceptance decisions.
  • Improved utilization of high-KDPI kidneys may be achieved through better assessment strategies.