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The Kidney Donor Profile Index (KDPI) of Marginal Donors Allocated by Standardized Pre-Transplant 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 M; 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 PMID25155294show ga
Pre-transplant 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 US. 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 eGFRs were significantly lower in recipients of marginal kidneys (-9.3, -17.9, and -18.8ml/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 to 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.