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Utility of Applying Quality Assessment Tools for Kidneys With KDPI ≥80.
- Source :
-
Transplantation [Transplantation] 2017 Jun; Vol. 101 (6), pp. 1125-1133. - Publication Year :
- 2017
-
Abstract
- Background: Kidneys with "high" Kidney Donor Profile Index (KDPI) are often biopsied and pumped, yet frequently discarded.<br />Methods: In this multicenter study, we describe the characteristics and outcomes of kidneys with KDPI of 80 or greater that were procured from 338 deceased donors. We excluded donors with anatomical kidney abnormalities.<br />Results: Donors were categorized by the number of kidneys discarded: (1) none (n = 154, 46%), (2) 1 discarded and 1 transplanted (n = 48, 14%), (3) both discarded (n = 136, 40%). Donors in group 3 were older, more often white, and had higher terminal creatinine and KDPI than group 1 (all P < 0.05). Biopsy was performed in 92% of all kidneys, and 47% were pumped. Discard was associated with biopsy findings and first hour renal resistance. Kidney injury biomarker levels (neutrophil gelatinase-associated lipocalin, IL-18, and kidney injury molecule-1 measured from donor urine at procurement and from perfusate soon after pump perfusion) were not different between groups. There was no significant difference in 1-year estimated glomerular filtration rate or graft failure between groups 1 and 2 (41.5 ± 18 vs 41.4 ± 22 mL/min per 1.73 m; P = 0.97 and 9% vs 10%; P = 0.76).<br />Conclusions: Kidneys with KDPI of 80 or greater comprise the most resource consuming fraction of our donor kidney pool and have the highest rates of discard. Our data suggest that some discarded kidneys with KDPI of 80 or greater are viable; however, current tools and urine and perfusate biomarkers to identify these viable kidneys are not satisfactory. We need better methods to assess viability of kidneys with high KDPI.
- Subjects :
- Adult
Aged
Biomarkers metabolism
Biopsy
Donor Selection methods
Female
Graft Survival
Humans
Kaplan-Meier Estimate
Kidney metabolism
Kidney Transplantation adverse effects
Kidney Transplantation methods
Male
Middle Aged
Predictive Value of Tests
Prospective Studies
Risk Assessment
Risk Factors
Tissue Survival
Treatment Outcome
United States
Decision Support Techniques
Donor Selection standards
Kidney pathology
Kidney Transplantation standards
Process Assessment, Health Care standards
Quality Indicators, Health Care standards
Tissue Donors supply & distribution
Subjects
Details
- Language :
- English
- ISSN :
- 1534-6080
- Volume :
- 101
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- Transplantation
- Publication Type :
- Academic Journal
- Accession number :
- 27490414
- Full Text :
- https://doi.org/10.1097/TP.0000000000001388