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2014 ; 14
(11
): 2515-25
Nephropedia Template TP
gab.com Text
Twit Text FOAVip
Twit Text #
English Wikipedia
The Kidney Donor Profile Index (KDPI) of marginal donors allocated by
standardized pretransplant donor biopsy assessment: distribution and association
with graft outcomes
#MMPMID25155294
Gandolfini I
; Buzio C
; Zanelli P
; Palmisano A
; Cremaschi E
; Vaglio A
; Piotti G
; Melfa L
; La Manna G
; Feliciangeli G
; Cappuccilli M
; Scolari MP
; Capelli I
; Panicali L
; Baraldi O
; Stefoni S
; Buscaroli A
; Ridolfi L
; D'Errico A
; Cappelli G
; Bonucchi D
; Rubbiani E
; Albertazzi A
; Mehrotra A
; Cravedi P
; Maggiore U
Am J Transplant
2014[Nov]; 14
(11
): 2515-25
PMID25155294
show ga
Pretransplant donor biopsy (PTDB)-based marginal donor allocation systems to
single or dual renal transplantation could increase the use of organs with Kidney
Donor Profile Index (KDPI) in the highest range (e.g. >80 or >90), whose discard
rate approximates 50% in the United States. To test this hypothesis, we
retrospectively calculated the KDPI and analyzed the outcomes of 442 marginal
kidney transplants (340 single transplants: 278 with a PTDB Remuzzi score<4
[median KDPI: 87; interquartile range (IQR): 78-94] and 62 with a score=4 [median
KDPI: 87; IQR: 76-93]; 102 dual transplants [median KDPI: 93; IQR: 86-96]) and
248 single standard transplant controls (median KDPI: 36; IQR: 18-51). PTDB-based
allocation of marginal grafts led to a limited discard rate of 15% for kidneys
with KDPI of 80-90 and of 37% for kidneys with a KDPI of 91-100. Although 1-year
estimated GFRs were significantly lower in recipients of marginal kidneys (-9.3,
-17.9 and -18.8?mL/min, for dual transplants, single kidneys with PTDB score<4
and =4, respectively; p<0.001), graft survival (median follow-up 3.3 years) was
similar between marginal and standard kidney transplants (hazard ratio: 1.20 [95%
confidence interval: 0.80-1.79; p=0.38]). In conclusion, PTDB-based allocation
allows the safe transplantation of kidneys with KDPI in the highest range that
may otherwise be discarded.