title: Utility of Applying Quality Assessment Tools for Kidneys With KDPI ≥80.
abstract: Kidneys with "high" Kidney Donor Profile Index (KDPI) are often biopsied and pumped, yet frequently discarded.
  
  
  
  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.
  
  
  
  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).
  
  
  
  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.
authors.affiliation: 1 Division of Nephrology, Department of Medicine, Wayne State University School of Medicine, Detroit, MI. 2 Renal-Electrolyte and Hypertension Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA. 3 Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA. 4 Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA. 5 Division of Nephrology, Hypertension & Renal Transplantation, Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT. 6 Section of Nephrology, University Hospital, Ulm, Germany. 7 Program of Applied Translational Research, Department of Medicine, Yale University School of Medicine, New Haven, CT. 8 Section of Nephrology, Yale University School of Medicine, New Haven, CT. 9 Saint Barnabas Medical Center, Livingston, NJ. 10 Gift of Life Institute, Philadelphia, PA. 11 Veterans Affairs Connecticut Healthcare System, New Haven, CT.
authors.forename: Mona D
authors.initials: MD
authors.lastname: Doshi
authors.forename: Peter P
authors.initials: PP
authors.lastname: Reese
authors.forename: Isaac E
authors.initials: IE
authors.lastname: Hall
authors.forename: Bernd
authors.initials: B
authors.lastname: Schröppel
authors.forename: Joseph
authors.initials: J
authors.lastname: Ficek
authors.forename: Richard N
authors.initials: RN
authors.lastname: Formica
authors.forename: Francis L
authors.initials: FL
authors.lastname: Weng
authors.forename: Rick D
authors.initials: RD
authors.lastname: Hasz
authors.forename: Heather
authors.initials: H
authors.lastname: Thiessen-Philbrook
authors.forename: Chirag R
authors.initials: CR
authors.lastname: Parikh
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000378:metabolism; D001706:Biopsy; D003661:Decision Support Techniques; D046148:Donor Selection / Q000379:methods / Q000592:standards*; D005260:Female; D006085:Graft Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000378:metabolism / Q000473:pathology*; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods / Q000592:standards*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D017064:Process Assessment, Health Care / Q000592:standards*; D011446:Prospective Studies; D019984:Quality Indicators, Health Care / Q000592:standards*; D018570:Risk Assessment; D012307:Risk Factors; D014019:Tissue Donors / Q000600:supply & distribution*; D014022:Tissue Survival; D016896:Treatment Outcome; D014481:United States
chemical_list: D015415:Biomarkers