The living kidney donor profile index fails to discriminate allograft survival:

[Clark]

https://www.amjtransplant.org/article/S1600-6135(22)24775-3/fulltext

ORIGINAL ARTICLE| VOLUME 23, ISSUE 2, P232-238, FEBRUARY 2023

The living kidney donor profile index fails to discriminate allograft survival: implications for its use in kidney paired donation programs

      Georgina L. Irish
Lachlan C. McMichael
Matthew Kadatz

      Edward Sharples
John S. Gill

Philip A. Clayton
et al.

American Journal of Transplantation
Published:December 05, 2022
DOI:https://doi.org/10.1016/j.ajt.2022.10.001

Abstract
The inclusion of blood group– and human leukocyte antigen–compatible donor and recipient pairs (CPs) in kidney paired donation (KPD) programs is a novel strategy to increase living donor (LD) transplantation. Transplantation from a donor with a better Living Donor Kidney Profile Index (LKDPI) may encourage CP participation in KPD programs. We undertook parallel analyses using data from the Scientific Registry of Transplant Recipients and the Australia and New Zealand Dialysis and Transplant Registry to determine whether the LKDPI discriminates death-censored graft survival (DCGS) between LDs. Discrimination was assessed by the following: (1) the change in the Harrell C statistic with the sequential addition of variables in the LKDPI equation to reference models that included only recipient factors and (2) whether the LKDPI discriminated DCGS among pairs of prognosis-matched LD recipients. The addition of the LKDPI to reference models based on recipient variables increased the C statistic by only 0.02. Among prognosis-matched pairs, the C statistic in Cox models to determine the association of the LKDPI with DCGS was no better than chance alone (0.51 in the Scientific Registry of Transplant Recipient and 0.54 in the Australia and New Zealand Dialysis and Transplant Registry cohorts). We conclude that the LKDPI does not discriminate DCGS and should not be used to promote CP participation in KPD programs.