title: Kidney donor risk index is a good prognostic tool for graft outcomes in deceased donor kidney transplantation with short, cold ischemic time.
abstract: BACKGROUND
  We performed a retrospective cohort study to determine the prognostic value of standard criteria donor/expanded criteria donor (SCD/ECD) designation, with regard to one-yr GFR and graft survival rate, in a region with short, cold ischemic time (CIT), and how this designation compares with the kidney donor risk index (KDRI) and zero-time kidney biopsies.
  
  
  METHODS
  We reviewed 362 cases of deceased donor kidney transplantation (DDKT). Donor kidneys were classified as SCD or ECD. They were also assessed by the KDRI. Zero-time kidney biopsy was performed in 196 patients, and histologic score was assessed.
  
  
  RESULTS
  Median follow-up duration was 46 months. Forty-two cases (11.6%) used ECD kidneys. The mean CIT was only 4.9 ± 2.7 h. Graft survival rates were not significantly different between ECD and SCD groups. The KDRI showed the best correlation with one-yr estimations of glomerular filtration rate (eGFR) (R(2) = 0.230, p < 0.001), and higher KDRI was associated with a higher risk of graft failure (hazard ratio 2.63, 95% confidence interval 1.01-6.87). However, higher histologic score was not associated with a higher risk of graft failure.
  
  
  CONCLUSIONS
  KDRI has greater predictive value for short-term outcomes in DDKT with short CIT than the SCD/ECD designation or pathology.
authors: Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
authors: Miyeun
authors: M
authors: Han
authors: Jong Cheol
authors: JC
authors: Jeong
authors: Tai Yeon
authors: TY
authors: Koo
authors: Hee Jung
authors: HJ
authors: Jeon
authors: Hyuk Yong
authors: HY
authors: Kwon
authors: Yoon Jung
authors: YJ
authors: Kim
authors: Hyun Jin
authors: HJ
authors: Ryu
authors: Curie
authors: C
authors: Ahn
authors: Jaeseok
authors: J
authors: Yang
mesh_terms: D000328:Adult; D002102:Cadaver; D050377:Cold Ischemia; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000401:mortality*; D006085:Graft Survival; D006801:Humans; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D015996:Survival Rate; D014019:Tissue Donors; D009927:Tissue and Organ Procurement
keywords: cold ischemic time; expanded criteria donor; graft survival; kidney transplantation