title: A Risk Index for Living Donor Kidney Transplantation.
abstract: Choosing between multiple living kidney donors, or evaluating offers in kidney paired donation, can be challenging because no metric currently exists for living donor quality. Furthermore, some deceased donor (DD) kidneys can result in better outcomes than some living donor kidneys, yet there is no way to compare them on the same scale. To better inform clinical decision-making, we created a living kidney donor profile index (LKDPI) on the same scale as the DD KDPI, using Cox regression and adjusting for recipient characteristics. Donor age over 50 (hazard ratio [HR] per 10 years = 1.15 1.241.33 ), elevated BMI (HR per 10 units = 1.01 1.091.16 ), African-American race (HR = 1.15 1.251.37 ), cigarette use (HR = 1.09 1.161.23 ), as well as ABO incompatibility (HR = 1.03 1.271.58 ), HLA B (HR = 1.03 1.081.14 ) mismatches, and DR (HR = 1.04 1.091.15 ) mismatches were associated with greater risk of graft loss after living donor transplantation (all p < 0.05). Median (interquartile range) LKDPI score was 13 (1-27); 24.2% of donors had LKDPI < 0 (less risk than any DD kidney), and 4.4% of donors had LKDPI > 50 (more risk than the median DD kidney). The LKDPI is a useful tool for comparing living donor kidneys to each other and to deceased donor kidneys.
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.|Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD.
authors.forename: A B
authors.initials: AB
authors.lastname: Massie
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: J
authors.initials: J
authors.lastname: Leanza
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: L M
authors.initials: LM
authors.lastname: Fahmy
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: E K H
authors.initials: EK
authors.lastname: Chow
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: N M
authors.initials: NM
authors.lastname: Desai
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: X
authors.initials: X
authors.lastname: Luo
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: E A
authors.initials: EA
authors.lastname: King
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: M G
authors.initials: MG
authors.lastname: Bowring
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.|Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD.|Scientific Registry for Transplant Recipients, Minneapolis, MN.
authors.forename: D L
authors.initials: DL
authors.lastname: Segev
mesh_terms: D000328:Adult; D000066491:Clinical Decision-Making; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006084:Graft Rejection / Q000453:epidemiology*; D006085:Graft Survival; D006801:Humans; D007676:Kidney Failure, Chronic / Q000601:surgery*; D007677:Kidney Function Tests; D016030:Kidney Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D018570:Risk Assessment / Q000379:methods*; D014481:United States / Q000453:epidemiology
keywords: clinical research/practice; graft survival; kidney transplantation/nephrology; kidney transplantation: living donor