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Trends in Usage and Outcomes for Expanded Criteria Donor Kidney Transplantation in the United States Characterized by Kidney Donor Profile Index.

Publication ,  Journal Article
Rege, A; Irish, B; Castleberry, A; Vikraman, D; Sanoff, S; Ravindra, K; Collins, B; Sudan, D
Published in: Cureus
November 22, 2016

There has been increasing concern in the kidney transplant community about the declining use of expanded criteria donors (ECD) despite improvement in survival and quality of life. The recent introduction of the Kidney Donor Profile Index (KDPI), which provides a more granular characterization of donor quality, was expected to increase utilization of marginal kidneys and decrease the discard rates. However, trends and practice patterns of ECD kidney utilization on a national level based on donor organ quality as per KDPI are not well known. We, therefore, performed a trend analysis of all ECD recipients in the United Network for Organ Sharing (UNOS) registry between 2002 and 2012, after calculating the corresponding KDPI, to enable understanding the trends of usage and outcomes based on the KDPI characterization. High-risk recipient characteristics (diabetes, body mass index ≥30 kg/m2, hypertension, and age ≥60 years) increased over the period of the study (trend test p<0.001 for all). The proportion of ECD transplants increased from 18% in 2003 to a peak of 20.4% in 2008 and then declined thereafter to 17.3% in 2012. Using the KDPI >85% definition, the proportion increased from 9.4% in 2003 to a peak of 12.1% in 2008 and declined to 9.7% in 2012. Overall, although this represents a significant utilization of kidneys with KDPI >85% over time (p<0.001), recent years have seen a decline in usage, probably related to regulations imposed by Centers for Medicare & Medicaid Services (CMS). When comparing the hazards of graft failure by KDPI, ECD kidneys with KDPI >85% have a slightly lower risk of graft failure compared to standard criteria donor (SCD) kidneys with KDPI >85%, with a hazard ratio (HR) of 0.95, a confidence interval (CI) of 0.94-0.96, and statistical significance of p<0.001. This indicates that some SCD kidneys may actually have a lower estimated quality, with a higher Kidney Donor Risk Index (KDRI), than some ECDs. The incidence of delayed graft function (DGF) in ECD recipients has significantly decreased over time from 35.2% in 2003 to 29.6% in 2011 (p=0.007), probably related to better understanding of the donor risk profile along with increased use of hypothermic machine perfusion and pretransplant biopsy to aid in optimal allograft selection. The recent decline in transplantation of KDPI >85% kidneys probably reflects risk-averse transplant center behavior. Whether discard of discordant SCD kidneys with KDPI >85% has contributed to this decline remains to be studied.

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Published In

Cureus

DOI

ISSN

2168-8184

Publication Date

November 22, 2016

Volume

8

Issue

11

Start / End Page

e887

Location

United States

Related Subject Headings

  • 42 Health sciences
  • 32 Biomedical and clinical sciences
  • 11 Medical and Health Sciences
 

Citation

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Chicago
ICMJE
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Rege, A., Irish, B., Castleberry, A., Vikraman, D., Sanoff, S., Ravindra, K., … Sudan, D. (2016). Trends in Usage and Outcomes for Expanded Criteria Donor Kidney Transplantation in the United States Characterized by Kidney Donor Profile Index. Cureus, 8(11), e887. https://doi.org/10.7759/cureus.887
Rege, Aparna, Bill Irish, Anthony Castleberry, Deepak Vikraman, Scott Sanoff, Kadiyala Ravindra, Bradley Collins, and Debra Sudan. “Trends in Usage and Outcomes for Expanded Criteria Donor Kidney Transplantation in the United States Characterized by Kidney Donor Profile Index.Cureus 8, no. 11 (November 22, 2016): e887. https://doi.org/10.7759/cureus.887.
Rege A, Irish B, Castleberry A, Vikraman D, Sanoff S, Ravindra K, et al. Trends in Usage and Outcomes for Expanded Criteria Donor Kidney Transplantation in the United States Characterized by Kidney Donor Profile Index. Cureus. 2016 Nov 22;8(11):e887.
Rege, Aparna, et al. “Trends in Usage and Outcomes for Expanded Criteria Donor Kidney Transplantation in the United States Characterized by Kidney Donor Profile Index.Cureus, vol. 8, no. 11, Nov. 2016, p. e887. Pubmed, doi:10.7759/cureus.887.
Rege A, Irish B, Castleberry A, Vikraman D, Sanoff S, Ravindra K, Collins B, Sudan D. Trends in Usage and Outcomes for Expanded Criteria Donor Kidney Transplantation in the United States Characterized by Kidney Donor Profile Index. Cureus. 2016 Nov 22;8(11):e887.

Published In

Cureus

DOI

ISSN

2168-8184

Publication Date

November 22, 2016

Volume

8

Issue

11

Start / End Page

e887

Location

United States

Related Subject Headings

  • 42 Health sciences
  • 32 Biomedical and clinical sciences
  • 11 Medical and Health Sciences