A Prognostic Index for Deceased Donor Kidneys and Criteria for Identifying Suitable Candidates for Kidney Transplantation from Expanded Criteria Donors with Prolonged Waiting Times.

IF 3.2 4区 医学 Q1 UROLOGY & NEPHROLOGY
Kidney Diseases Pub Date : 2025-02-20 eCollection Date: 2025-01-01 DOI:10.1159/000544792
Tai Yeon Koo, Joongyub Lee, Omi Na, Yonggu Lee, Jong Cheol Jeong, Jaeseok Yang
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引用次数: 0

Abstract

Introduction: The kidney donor profile index (KDPI) is a valuable prognostic tool in deceased donor kidney transplantation (DDKT), while its optimization for each country using local data is essential. It remains unclear which patients derive survival benefits from expanded criteria donor (ECD) DDKT compared to waitlist or standard criteria donor (SCD) DDKT, particularly in the context of long waiting times. This study aimed to develop a prognostic index for donor kidneys and propose criteria to identify suitable candidates for ECD DDKT in Korea.

Methods: Two prediction models were developed using data from two cohorts based on national databases (the Korean Network for Organ Sharing and the National Health Insurance Data Sharing Service): cohort for the prediction of graft prognosis (n = 6,272) and cohort for the prediction of suitable candidates for ECD DDKT (n = 30,183).

Results: The Korean KDPI (K-KDPI) comprises five donor factors (age, height, diabetes mellitus, serum creatinine levels, and hepatitis C virus), associated with graft failure. The discriminatory ability of the K-KDPI for graft outcomes surpassed that of the US KDPI and dichotomous ECD criteria. ECD kidneys (K-KDPI ≥70%) showed worse allograft survival compared to SCD kidneys (K-KDPI <70%). Candidates aged ≥40 years, with negative panel reactive antibody, and without diabetes mellitus had a significantly lower mortality risk with ECD DDKT than with waitlist-or-SCD DDKT, making them suitable for ECD DDKT.

Conclusion: The K-KDPI and criteria for identifying suitable ECD recipients are expected to improve the quality assessment and efficient utilization of ECD kidneys in Korea with long waiting times.

死亡捐献者肾脏的预后指数以及从等待时间较长的扩大标准捐献者中确定肾移植合适候选者的标准。
肾供者概况指数(KDPI)是一种有价值的预测已故供者肾移植(DDKT)的工具,而利用当地数据对每个国家进行优化是至关重要的。与等待名单或标准标准供体(SCD) DDKT相比,目前尚不清楚哪些患者从扩展标准供体(ECD) DDKT中获得生存益处,特别是在等待时间较长的情况下。本研究旨在制定供体肾脏的预后指数,并提出标准,以确定韩国ECD DDKT的合适候选人。方法:使用基于国家数据库(韩国器官共享网络和国民健康保险数据共享服务)的两个队列的数据建立了两个预测模型:预测移植物预后的队列(n = 6272)和预测适合ECD DDKT候选人的队列(n = 30,183)。结果:韩国KDPI (K-KDPI)包括与移植失败相关的5个供体因素(年龄、身高、糖尿病、血清肌酐水平和丙型肝炎病毒)。K-KDPI对移植结果的区分能力超过了美国KDPI和二分ECD标准。结论:K-KDPI和确定合适ECD受体的标准有望改善韩国等待时间较长的ECD肾脏的质量评估和有效利用。
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来源期刊
Kidney Diseases
Kidney Diseases UROLOGY & NEPHROLOGY-
CiteScore
6.00
自引率
2.70%
发文量
33
审稿时长
27 weeks
期刊介绍: ''Kidney Diseases'' aims to provide a platform for Asian and Western research to further and support communication and exchange of knowledge. Review articles cover the most recent clinical and basic science relevant to the entire field of nephrological disorders, including glomerular diseases, acute and chronic kidney injury, tubulo-interstitial disease, hypertension and metabolism-related disorders, end-stage renal disease, and genetic kidney disease. Special articles are prepared by two authors, one from East and one from West, which compare genetics, epidemiology, diagnosis methods, and treatment options of a disease.
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