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