The association between the Kidney Donor Profile Index and one-year outcomes in Brazilian kidney transplant recipients of standard criteria donors.

Abstract

Introduction: The Kidney Donor Profile Index (KDPI) has not been previously validated in Brazil, thus this study aimed to investigate the association between the index and one-year outcomes in kidney transplant recipients (KTRs) of standard criteria donors (SCD).

Methods: Retrospective cohort analysis including 1,943 KTRs who received kidneys from SCD between 2013 and 2017. The primary outcome was composed of death, graft loss, and 1-yr-graft function <30 mL/min/1.73m2 (eGFR, CKD-EPI). Logistic regression identified variables associated with the primary outcome, while 1-yr eGFR across KDPI strata was compared using the Kruskal-Wallis test, adjusted with the Bonferroni test.

Results: Donors were 41.0 years old, 24.9% had hypertension, 47.3% died due to cerebrovascular injury, and 48.3% had the final creatinine >1.5 mg/dL; the median of KDPI was 52%. The primary outcome occurred in 14.4% of the cases, which was associated with longer dialysis duration before transplantation (p = 0.04), CMV-related events (p = 0.03), acute rejection (p < 0.001), and KDPI strata. Compared to the 1-35% KDPI stratum, the RRs for the primary outcome were significantly higher in higher KDPI strata: 1.62 (p = 0.03) for >35-50%, 2.28 (p < 0.001) for >50-85%, and 2.23 (p = 0.01) for >85%. The 1-yr eGFR was also significantly lower in KTRs with donors in higher KDPI strata (p < 0.001).

Conclusion: The KDPI was independently associated with the primary outcome composed of death, graft loss, and 1-yr eGFR <30 mL/min/1.73 m2 in recipients of SCD donors. Despite not being previously validated for Brazilian donors, the KDPI was also significantly associated with 1-yr eGFR, delayed graft function, and acute rejection in those recipients.