Clinical Significance of the Living Kidney Donor Profile Index in Living Kidney Donors for Predicting of Post-Transplant Outcome: Korean Organ Transplantation Registry

Abstract

Purpose: According to recent reports, a risk index for living donor kidney trans-plantation (LDKT) such as the Kidney donor profile index (KDPI), a non-invasive method for assessing the kidneys of deceased donors prior to transplantation, has been studied. In this study, data were collected from donors and recipients registered in the Korean Organ Transplantation Registry (KOTRY) with retrospective medical records and prospective follow-up cohorts of patients undergoing renal transplantation. We analyze the living kidney donor profile index (LKDPI) with data from KOTRY, and confirm if LKDPI could be a tool to predict the survival of allograft in LDKT.

Methods: The study population was derived from the KOTRY database. From April 2014 to December 2020, 5403 kidney recipients registered in the KOTRY database were enrolled. Donor information (donation date, age, sex, race, blood type, BMI, History, HLA typing, previous hemodialysis and kidney transplantation, lab finding, etc.), and recipients information (kidney transplant date, age, sex, race, BMI, blood type, HLA typing, the result of survival, renal function, lab finding, etc.) were observed. LKDPI was measured with these factors and analyzed whether the LKDPI score could predict the graft loss.

Results: Of the 5403 kidney recipients, 2598 (Men: 1112, Women: 1486, median age: 47.7) who received LDKT were evaluated with LKDPI. Median LKDPI was 15.5. Patients were divided into three groups based on LKDPI score. Then, two groups with low LKDPI were grouped together and compared with the group with the highest LKDPI. We validated that the higher LKDPI score was the higher death-censored graft loss risk (HR = 1.178; 95% CI 1.112-2.655; P = 0.015). In multivariate analysis which corrected recipient factors affecting graft loss risk, the same results were founded. Higher LKDPI score group showed higher risk of death-censored graft loss (HR = 1.721; 95% CI 1.109-2.671; P = 0.015).

Conclusions: In this study, we confirmed that LKDPI could be an independent predictor for assessing the risk of allograft failure and outcome in a Korea LDKT. It may be useful and helpful for patients who are struggling between waiting DDKT and going LDKT.