Evaluation of Scoring Systems in Kidney Transplantation: A Single Center Experience

The global shortage of donor organs has led to increasing efforts to optimize the allocation process of renal allografts.

We conducted our study at the University of Debrecen, utilizing data pertaining to kidney transplants that were performed between January 1, 2018, and December 31, 2022. We used expanded criteria donor (ECD), kidney donor profile index (KDPI), and kidney donor risk index (KDRI) criteria systems to evaluate donor kidneys. We wanted to measure graft function and 3- to 5-year graft survival of kidneys offered to our center.

During this time frame, 830 kidneys were offered to our center, and 160 were successfully transplanted. Looking at them, it can be observed that, based on the ECD/standard criteria donor (SCD) criteria systems, 5-year graft survival significantly differs in the 2 groups, which confirms the use of the criteria systems in clinical practice. Moreover, it can also be stated that using KDPI classification for the ECD group, there are donor kidneys (KDPI <85) which have the same characteristics as SCD donor kidneys. Thus, the KDPI criteria system is better suited to project expected graft survival of donor kidneys. This is also confirmed by the 3-year graft survival of the kidneys, discarded by us but transplanted elsewhere, which also shows that lower graft survival is only observable in the group with a KDPI of more than 85.

Taking the weaknesses of KDPI into account, it is really important to use tools that were developed to assess kidneys that can contribute to maximizing organ utilization, as quality of life of end-stage kidney disease patients can only be improved by transplantation.