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Darren E Stewart, Victoria C Garcia, Mark I Aeder, David K Klassen
The Kidney Donor Profile Index (KDPI) became a driving factor in deceased donor kidney allocation on December 4, 2014 with the implementation of the kidney allocation system (KAS). On April 20, 2016, the annual recalibration of the Kidney Donor Risk Index (KDRI) into KDPI was incorrectly programmed in DonorNet, resulting in erroneously-high KDPI values from between 1 and 21 percentage points (e.g., actual KDPI of 70% was displayed as 86%). The error was corrected on May 19, 2016, less than 24 hours after being recognized...
May 28, 2017: American Journal of Transplantation
Dimitris Bertsimas, Jerry Kung, Nikolaos Trichakis, David Wojciechowski, Parsia A Vagefi
BACKGROUND: When a deceased-donor kidney is offered to a waitlisted candidate, the decision to accept or decline the organ relies primarily upon a practitioner's experience and intuition. Such decisions must achieve a delicate balance between estimating the immediate benefit of transplantation and the potential for future higher-quality offers. However, the current experience-based paradigm lacks scientific rigor and is subject to the inaccuracies that plague anecdotal decision-making...
May 17, 2017: Transplantation
Giovanni Stallone, Giuseppe Grandaliano
In this issue of Transplantation International, Sanchez-Escudero et al [1] report the results obtained from a prospective single centre study enrolling 485 consecutive transplant recipients receiving a kidney with a Remuzzi score (RS) [2] of Pre Transplant Donor Biopsies (PTDB) lower or equal to 4. Then retrospectively, the authors compared their organ allocation policy based on RS with kidney donor profile index (KDPI) [3] and evaluated the discard rate between KDPI and PTDB and five years graft and patients survival...
May 11, 2017: Transplant International: Official Journal of the European Society for Organ Transplantation
Ana Sánchez-Escuredo, Amaia Sagasta, Ignacio Revuelta, Lida M Rodas, David Paredes, Mireia Musquera, Fritz Diekmann, Josep M Campistol, Manel Solé, Federico Oppenheimer
There is no consensus on the allocation of renal transplants from expanded criteria donors (ECD). The Kidney Donor Profile Index (KDPI) is used without the need for pretransplant donor biopsies (PTDB). We explored whether PTDB based on Remuzzi Score (RS) allows identification of those marginal kidneys in the highest calculated KDPI risk group (>91%) that appropriate for single transplantation. A retrospective study was conducted of 485 consecutive kidneys procured from a single center and transplanted if the RS was ≤4...
April 12, 2017: Transplant International: Official Journal of the European Society for Organ Transplantation
Colleen Jay, Jacqueline Pugh, Glenn Halff, Greg Abrahamian, Francisco Cigarroa, Ken Washburn
BACKGROUND: Poor renal function is associated with higher mortality after liver transplantation. Our aim was to understand the impact of kidney graft quality according to the kidney donor profile index (KDPI) score on survival after simultaneous liver-kidney (SLK) transplantation. METHODS: Using United Network of Organ Sharing data from 2002 to 2013 for adult deceased donor SLK recipients, we compared survival and renal graft outcomes according to KDPI. RESULTS: Of 4207 SLK transplants, 6% were from KDPI >85% donors...
May 2017: Clinical Transplantation
María José Pérez-Sáez, Núria Montero, Dolores Redondo-Pachón, Marta Crespo, Julio Pascual
The old-for-old allocation policy used for kidney transplantation (KT) has confirmed the survival benefit compared to remaining listed on dialysis. Shortage of standard donors has stimulated the development of strategies aimed to expand acceptance criteria, particularly of kidneys from elderly donors. We have systematically reviewed the literature on those different strategies. In addition to the review of outcomes of expanded criteria donor or advanced age kidneys, we assessed the value of the Kidney Donor Profile Index policy, preimplantation biopsy, dual KT, machine perfusion and special immunosuppressive protocols...
April 2017: Transplantation
Aparna Rege, Bill Irish, Anthony Castleberry, Deepak Vikraman, Scott Sanoff, Kadiyala Ravindra, Bradley Collins, Debra Sudan
There has been increasing concern in the kidney transplant community about the declining use of expanded criteria donors (ECD) despite improvement in survival and quality of life. The recent introduction of the Kidney Donor Profile Index (KDPI), which provides a more granular characterization of donor quality, was expected to increase utilization of marginal kidneys and decrease the discard rates. However, trends and practice patterns of ECD kidney utilization on a national level based on donor organ quality as per KDPI are not well known...
November 22, 2016: Curēus
J L Wainright, A Y Kucheryavaya, D K Klassen, D E Stewart
This study investigated the early effects of the new kidney allocation system (KAS) on the access of prior living kidney donors (PLDs) to deceased donor kidney transplants. Using data from the Organ Procurement and Transplantation Network, we compared prevalent and incident cohorts of PLDs in the 1-year periods before and after KAS implementation (pre-KAS group: December 4, 2013, to December 3, 2014, n = 50 [newly listed PLDs]; post-KAS group: December 4, 2014, to December 3, 2015, n = 39). We assessed transplant rates per active patient-year, waiting times, and Kidney Donor Profile Index (KDPI) of transplanted kidneys...
April 2017: American Journal of Transplantation
Astha Gupta, George Francos, Adam M Frank, Ashesh P Shah
BACKGROUND: Efforts have been made to maximize the utility of each organ transplanted. Policy changes to capture unrealized graft years have been implemented utilizing the kidney donor profile index (KDPI). Understanding the impact of KDPI on long-term graft function is critical to an informed organ acceptance decision. METHODS: We reviewed the records of 309 consecutive deceased adult donor kidney recipients who underwent kidney transplantation at our center. We obtained KDPI of the allografts directly from United Network for Organ Sharing (UNOS) and patients were divided into four categories: KDPI ≤ 20, KDPI 21 - 35, KDPI 36 - 85, and KDPI > 85...
October 2016: Clinical Nephrology
Francesca M Dimou, Hemalkumar B Mehta, Deepak Adhikari, Robert C Harland, Taylor S Riall, Yong-Fang Kuo
BACKGROUND: Nonalcoholic steatohepatitis is expected to become the leading indication for liver transplantation. Use of extended criteria donors (ECD) may help with donor allocation in these patients. The objective of this study was to determine the use of ECDs in patients with nonalcoholic steatohepatitis undergoing liver transplantation to stimulate a liver-specific predictive model for ECD use. METHODS: The United Network for Organ Sharing database was used to identify patients undergoing liver transplantation for nonalcoholic steatohepatitis (2002-2014)...
December 2016: Surgery
Colleen L Jay, Kenneth Washburn, Patrick G Dean, Ryan A Helmick, Jacqueline A Pugh, Mark D Stegall
BACKGROUND: Given high dialysis mortality rates for patients older than 60 years, accepting a kidney with a high Kidney Donor Profile Index (KDPI) score could enable earlier and potentially preemptive transplantation (preKT). However, evidence regarding the risks of high KDPI allografts in older patients is limited. Our objective was to determine the relative benefit for older patients of KDPI greater than 85% transplant either preemptively or not compared with remaining on the waitlist...
April 2017: Transplantation
Mona D Doshi, Peter P Reese, Isaac E Hall, Bernd Schröppel, Joseph Ficek, Richard N Formica, Francis L Weng, Rick D Hasz, Heather Thiessen-Philbrook, Chirag R Parikh
BACKGROUND: Kidneys with "high" Kidney Donor Profile Index (KDPI) are often biopsied and pumped, yet frequently discarded. 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. 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%)...
June 2017: Transplantation
Ronald P Pelletier, Todd E Pesavento, Amer Rajab, Mitchell L Henry
BACKGROUND: Deceased donor (DD) kidney quality is determined by calculating the Kidney Donor Profile Index (KDPI). Optimizing high KDPI (≥85%) DD transplant outcome is challenging. This retrospective study was performed to review our high KDPI DD transplant results to identify clinical practices that can improve future outcomes. METHODS: We retrospectively calculated the KDPI for 895 DD kidney recipients transplanted between 1/2002 and 11/2013. Age, race, body mass index (BMI), retransplantation, gender, diabetes (DM), dialysis time, and preexisting coronary artery disease (CAD) (previous myocardial infarction (MI), coronary artery bypass (CABG), or stenting) were determined for all recipients...
August 2016: Clinical Transplantation
Raymond L Heilman, Amit Mathur, Maxwell L Smith, Bruce Kaplan, Kunam S Reddy
This review will concentrate on the literature regarding donor kidneys that are currently being utilized at a relatively low rate. Donors with AKI seem to have outcomes equivalent to those without AKI provided one can rule out significant cortical necrosis. Donors with pre-existing diabetes or hypertension may have a marginally lower aggregate survival, but still provide a significant benefit over remaining on the wait list. As KDPI only derives an aggregate association with survival with a very modest C statistic, the data would indicate that this should not be the sole reason to discard a kidney except perhaps in patients with extremely low EPTS scores...
May 12, 2016: American Journal of Transplantation
Jagbir Gill, Jianghu Dong, Caren Rose, John S Gill
Concern about the long-term impact of delayed graft function (DGF) may limit the use of high-risk organs for kidney transplantation. To understand this better, we analyzed 29,598 mate kidney transplants from the same deceased donor where only 1 transplant developed DGF. The DGF associated risk of graft failure was greatest in the first posttransplant year, and in patients with concomitant acute rejection (hazard ratio: 8.22, 95% confidence interval: 4.76-14.21). In contrast, the DGF-associated risk of graft failure after the first posttransplant year in patients without acute rejection was far lower (hazard ratio: 1...
June 2016: Kidney International
Yousef Al-Shraideh, Umar Farooq, Hany El-Hennawy, Alan C Farney, Amudha Palanisamy, Jeffrey Rogers, Giuseppe Orlando, Muhammad Khan, Amber Reeves-Daniel, William Doares, Scott Kaczmorski, Michael D Gautreaux, Samy S Iskandar, Gloria Hairston, Elizabeth Brim, Margaret Mangus, Robert J Stratta
AIM: To compare outcomes between single and dual en bloc (EB) kidney transplants (KT) from small pediatric donors. METHODS: Monocentric nonprospective review of KTs from pediatric donors ≤ 5 years of age. Dual EB KT was defined as keeping both donor kidneys attached to the inferior vena cava and aorta, which were then used as venous and arterial conduits for the subsequent transplant into a single recipient. Donor age was less useful than either donor weight or kidney size in decision-making for kidney utilization as kidneys from donors < 8 kg or kidneys < 6 cm in length were not transplanted...
March 24, 2016: World Journal of Transplantation
J J Snyder, N Salkowski, A Wey, A K Israni, J D Schold, D L Segev, B L Kasiske
There is a perception that transplanting high-risk kidneys causes programs to be identified as underperforming, thereby increasing the frequency of discards and diminishing access to transplant. Thus, the Organ Procurement and Transplantation Network (OPTN) has considered excluding transplants using kidneys from donors with high Kidney Donor Profile Index (KDPI) scores (≥0.85) when assessing program performance. We examined whether accepting high-risk kidneys (KDPI ≥0.85) for transplant yields worse outcome evaluations...
September 2016: American Journal of Transplantation
S Bae, A B Massie, X Luo, S Anjum, N M Desai, D L Segev
Since March 26, 2012, the Kidney Donor Profile Index (KDPI) has been provided with all deceased-donor kidney offers, with the goal of improving the expanded criteria donor (ECD) indicator. Although an improved risk index may facilitate identification and transplantation of marginal yet viable kidneys, a granular percentile system may reduce provider-patient communication flexibility, paradoxically leading to more discards ("labeling effect"). We studied the discard rates of the kidneys recovered for transplantation between March 26, 2010 and March 25, 2012 ("ECD era," N = 28 636) and March 26, 2012 and March 25, 2014 ("KDPI era," N = 29 021) using Scientific Registry of Transplant Recipients (SRTR) data...
July 2016: American Journal of Transplantation
Michael S Martin, Michael E Hagan, Darla K Granger
BACKGROUND: The United Network for Organ Sharing began including the Kidney Donor Profile Index (KDPI) March 26, 2012 and began a new allocation scheme December 1, 2014. METHODS: Kidney donors from our organ procurement organization from March 2012 to December 2014 were reviewed. The KDPIs of all 919 kidney only transplants were compared with all 102 kidney/extrarenal transplants. RESULTS: The average KDPI for kidney alone allografts was 47 (range 1 to 100) (standard deviation = 25...
March 2016: American Journal of Surgery
William F Parker, J Richard Thistlethwaite, Lainie Friedman Ross
BACKGROUND: The new deceased donor kidney allocation algorithm uses a Kidney Donor Profile Index (KDPI) based on donor characteristics to predict graft survival and divides kidneys into 4 quality groups (ie, KDPI-A, -B, -C, and -D). Pediatric kidneys constitute 10% to 12% of deceased donor kidneys. We hypothesized that KDPI would not accurately predict pediatric donor graft survival and superior predictive models could be created. METHODS: Scientific Registry of Transplant Recipients data for years 2000 to 2010 for transplants from child (<10 years) and adolescent (10-17 years inclusive) donors into first-time adult recipients were analyzed with graft failure as the principle outcome...
November 2016: Transplantation
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