Transplantation Direct (May 2023)

The Association Between Kidney Donor Profile Index and 1-y Graft Function

  • Renato Demarchi Foresto, MD, MSc,
  • Maria Amelia Aguiar Hazin, MD, MSc,
  • Bianca Cristina Cassão, MD, MSc,
  • Ana Paula Aquino de Morais,
  • Claudia Rosso Felipe, PharmD, PhD,
  • Lucio R. Requião-Moura, MD, PhD,
  • José Medina Pestana, MD, PhD,
  • Helio Tedesco-Silva, MD, PhD

DOI
https://doi.org/10.1097/TXD.0000000000001476
Journal volume & issue
Vol. 9, no. 5
p. e1476

Abstract

Read online

Background. The association between Kidney Donor Profile Index (KDPI) and 1-y estimated glomerular filtration rate (eGFR) with long-term kidney graft survival is well known. Yet, the association between KDPI and 1-y eGFR remains uncertain considering the several concurrent competing risk factors. Methods. This single-center, retrospective cohort study analyzed data from 3059 consecutive deceased donor kidney transplant recipients with a 1-y follow-up from January 2013 to December 2017. The aim was to determine the association between the KDPI strata (0%–35%, 36%–50%, 51%–85%, 86%–100%) and 1-y eGFR estimated by the CKD-EPI equation. Results. The incidence of delayed graft function (50.6% versus 59.3% versus 62.7% versus 62.0%; P 35%–50% (HR = 2.239, 95% CI = 1.862–2.691), and >51%–85% (HR = 2.871, 95% CI = 2.361–3.491), respectively. Other variables associated with a lower graft function were donor sex (HR male versus female = 0.896, 95% CI = 0.813–0.989) and cold ischemia time (HR for each hour = 1.011, 95% CI = 1.004–1.019). This association was sustained after the Poisson mediation analysis, including delayed graft function, cytomegalovirus, and acute rejection as mediators. Conclusions. In this cohort of deceased donor kidney recipients, KDPI, and cold ischemia time were the major independent risk factors associated with lower 1-y kidney function.