title: The Kidney Donor Profile Index (KDPI) of marginal donors allocated by standardized pretransplant donor biopsy assessment: distribution and association with graft outcomes.
abstract: Pretransplant donor biopsy (PTDB)-based marginal donor allocation systems to single or dual renal transplantation could increase the use of organs with Kidney Donor Profile Index (KDPI) in the highest range (e.g. >80 or >90), whose discard rate approximates 50% in the United States. To test this hypothesis, we retrospectively calculated the KDPI and analyzed the outcomes of 442 marginal kidney transplants (340 single transplants: 278 with a PTDB Remuzzi score<4 [median KDPI: 87; interquartile range (IQR): 78-94] and 62 with a score=4 [median KDPI: 87; IQR: 76-93]; 102 dual transplants [median KDPI: 93; IQR: 86-96]) and 248 single standard transplant controls (median KDPI: 36; IQR: 18-51). PTDB-based allocation of marginal grafts led to a limited discard rate of 15% for kidneys with KDPI of 80-90 and of 37% for kidneys with a KDPI of 91-100. Although 1-year estimated GFRs were significantly lower in recipients of marginal kidneys (-9.3, -17.9 and -18.8 mL/min, for dual transplants, single kidneys with PTDB score<4 and =4, respectively; p<0.001), graft survival (median follow-up 3.3 years) was similar between marginal and standard kidney transplants (hazard ratio: 1.20 [95% confidence interval: 0.80-1.79; p=0.38]). In conclusion, PTDB-based allocation allows the safe transplantation of kidneys with KDPI in the highest range that may otherwise be discarded.
authors.affiliation: Kidney and Kidney-Pancreas Transplant Unit (Department of Nephrology), Parma University Hospital, Parma, Italy.
authors.forename: I
authors.initials: I
authors.lastname: Gandolfini
authors.forename: C
authors.initials: C
authors.lastname: Buzio
authors.forename: P
authors.initials: P
authors.lastname: Zanelli
authors.forename: A
authors.initials: A
authors.lastname: Palmisano
authors.forename: E
authors.initials: E
authors.lastname: Cremaschi
authors.forename: A
authors.initials: A
authors.lastname: Vaglio
authors.forename: G
authors.initials: G
authors.lastname: Piotti
authors.forename: L
authors.initials: L
authors.lastname: Melfa
authors.forename: G
authors.initials: G
authors.lastname: La Manna
authors.forename: G
authors.initials: G
authors.lastname: Feliciangeli
authors.forename: M
authors.initials: M
authors.lastname: Cappuccilli
authors.forename: M P
authors.initials: MP
authors.lastname: Scolari
authors.forename: I
authors.initials: I
authors.lastname: Capelli
authors.forename: L
authors.initials: L
authors.lastname: Panicali
authors.forename: O
authors.initials: O
authors.lastname: Baraldi
authors.forename: S
authors.initials: S
authors.lastname: Stefoni
authors.forename: A
authors.initials: A
authors.lastname: Buscaroli
authors.forename: L
authors.initials: L
authors.lastname: Ridolfi
authors.forename: A
authors.initials: A
authors.lastname: D'Errico
authors.forename: G
authors.initials: G
authors.lastname: Cappelli
authors.forename: D
authors.initials: D
authors.lastname: Bonucchi
authors.forename: E
authors.initials: E
authors.lastname: Rubbiani
authors.forename: A
authors.initials: A
authors.lastname: Albertazzi
authors.forename: A
authors.initials: A
authors.lastname: Mehrotra
authors.forename: P
authors.initials: P
authors.lastname: Cravedi
authors.forename: U
authors.initials: U
authors.lastname: Maggiore
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D005260:Female; D006085:Graft Survival; D006801:Humans; D007668:Kidney / Q000473:pathology; D008297:Male; D008875:Middle Aged; D014019:Tissue Donors
keywords: Biopsy; clinical research/practice; donors and donation: extended criteria; kidney (allograft) function/dysfunction; kidney transplantation/nephrology; organ acceptance; organ allocation