Kidney Donor Profile Index in the Case of Repeated Transplantation

Introduction. In 2014, new scoring system - Kidney Donor Profile Index (KDPI) was introduced. KDPI is a numerical measure that combines ten donor factors, including clinical parameters and demographics, to summarize into a single number the quality of deceased donor kidneys. There are some publications regarding usefulness of KDPI in the first kidney transplant recipients, however there are no data focusing on repeated transplantation patients. Aim of the Study. To determine the usefulness of kidney donor profile index as a risk marker of graft failure in repeated transplantation situations. Material and methods. A single-centre retrospective study was conducted. Patients who underwent a repeated transplantation from deceased donors between 2005. and 2013. were included in the study. Data about donor’s risk factors - age, height, weight, race, history of hypertension, history of diabetes, cause of death, serum creatinine, anti-HCV and if donor is after cardiac death - were collected and KDPI was calculated for all participants. Patients were divided into groups according to determined KDPI: Group 1 - KDPI <35%; Group 2 - KDPI 36 - 69%; Group 3 - KDPI >70%. For statistical analysis, IBM Statistical Package for the Social Sciences, version 21.0 was used. Results. A total of 72 patients were enrolled in the study. There were 17 patients (23.6%) in the 1. group, 38 patients (52.8%) in the 2. group and 17 patients (23.6%) in the 3. group. The most common cause of an end stage renal disease was chronic glomerulonephritis- 59.7% (n=43). Patients with higher KDPI developed acute rejection more often. In the group with KDPI <35% it was observed in 35.3%, while in the groups with KDPI 36 - 69% and KDPI >70% in 60.5% and 64.7% of patients, p = 0.02. Graft function differed significantly both, after one (p =0.01) and three years (p=0.04) with the highest eGFR results in the group with the lowest KDPI. The difference in graft survival rates was statistically significant, p = 0.027. After three- years it was 88.2% in the first group, 86.8% in the second group and 70.6% in the third group. Patient survival rates showed trend toward significance (p = 0.076) with only two patients lost during three- year follow up. Conclusions. KDPI presents relevance with repeated transplantation outcomes. Lower KDPI indicates better transplantation outcomes - superior graft function and better graft survival. However, there is only trend towards significance in patient survival rates.