Designing a KDPI to Assess Live Donors and Compare Them to Deceased Donors

[Clark]

http://www.atcmeetingabstracts.com/abstract/designing-a-kdpi-to-assess-live-donors-and-compare-them-to-deceased-donors/

Designing a KDPI to Assess Live Donors and Compare Them to Deceased Donors
A. Massie, D. Segev.
2015 American Transplant Congress
Abstract number: 1979

The Kidney Donor Profile Index (KDPI) is used to assess risk of deceased donor kidneys (DDKT) based on donor characteristics. No comparable index exists for living donor kidneys (LDKT). We present a new index of live donor risk, the LKDPI, on the same scale as the KDPI.

METHODS: We analyzed SRTR data on 75,156 adult DDKT and 43,193 LDKT recipients from 2004-2013. We modeled risk of all-cause graft loss as a function of KDPI (DDKT) and LD characteristics (LDKT) in a single Cox regression model, adjusting for recipient characteristics. The vector of coefficients for LD characteristics, multiplied by a vector of characteristics for a specific donor and divided by the coefficient for KDPI, yields a donor-specific risk score ("LKDPI") on the same scale as the KDPI.

RESULTS: The regression model (Table 1) and LKDPI equation (Table 2) are shown. Median (IQR) LKDPI score was 17 (6-26). Range of LKDPI was -21 to 107 (Figure 1); 9.7% of LD kidneys had LKDPI<0, indicating less predicted risk than all DD kidneys. As predicted, LDKT was associated with poorer graft survival (Figure 2).

CONCLUSIONS: LD kidneys with higher LKDPI have poorer graft survival. The LKDPI may aid in decisionmaking for transplant candidates with multiple potential live donors, or in evaluating DDKT offers when the patient has an available potential LD.

Live donor characteristic   aHR
(Age-50) if age>50   1.02 1.02 1.03
Male gender   0.86 0.90 0.94
African-American race   1.13 1.21 1.29
ABO incompatible   1.10 1.32 1.59
Unrelated to recipient   0.85 0.91 0.96
HLA-B mismatch   1.02 1.07 1.11
HLA-DR mismatch   1.06 1.11 1.15
Adjusted for recipient characteristics. All coefficients p<0.01
Calculation of LKDPI
2.43 *(age-50) if age>50
+ -10.72 if male
+ 19.25 if African-American
+ 28.64 if ABO incompatible
+ -10.04 if unrelated
+ 6.83 * (# HLA-B mismatches)
+ 10.36 * (# HLA-DR mismatches)
Example: 55-year-old, non-AA, related, ABO-matched female donor with 1 HLA-B mismatch = 2.43*(55-50)+6.83=18.98

Massie A, Segev D. Designing a KDPI to Assess Live Donors and Compare Them to Deceased Donors [abstract]. Am J Transplant. 2015; 15 (suppl 3). http://www.atcmeetingabstracts.com/abstract/designing-a-kdpi-to-assess-live-donors-and-compare-them-to-deceased-donors/. Accessed May 1, 2015.