D THARMARAJ1, M ROBERTS1,2, D LEE1,2
1Department of Renal Medicine, Eastern Health, 2Eastern Health Clinical School, Monash University
Aim: To examine the effect of the introduction of the Kidney Donor Profile Index (KDPI) on deceased donor kidney transplant (DDKT) acceptance rates.
Background: Since the introduction of KDPI reporting with all DDKT offers there have been concerns with a change in acceptance practice for higher KDPI kidneys previously considered acceptable.
Methods: Electronic donor records for DDKT offers between April 2014 and September 2019 at our centre were retrospectively reviewed. Acceptance rates before and after the introduction of KDPI reporting in November 2016 were compared, stratified by KDPI into standard (0-80%) and higher (81-100%) risk categories. KDPI for DDKT offers from the pre-reporting era was manually calculated (https://www.tsanz.com.au/standalonepages/document-download.asp).
Results: 211 offers were reviewed for 161 individual recipient-donor pairs. Including all offers, acceptance rates were similar between post- and pre-reporting eras (51/134 (38.1%) vs 36/77 (46.7%), respectively; P=0.22), but lower for higher risk kidneys (10/51 (19.6%) vs 11/26 (42.3%), respectively; p=0.03). There were no other differences in donor or recipient factors for higher risk kidneys between post and pre-reporting eras. Logistical regression analysis of the 161 recipient-donor pairs identified KDPI 81-100% as a predictor of low acceptance in the post-KDPI-reporting era (OR 0.17 (95%CI 0.06-0.48); P=0.001)), independent of HLA A-B-DR mismatches ≥5 (OR 0.31 (95%CI 0.10-0.90); P=0.03)) and Estimated Post-Transplant Survival (EPTS) score (OR 1.02 (95% CI 1.00-1.04); p=0.018)). KDPI was not a predictor in the pre-reporting era.
Conclusion: In this single centre study, KDPI reporting was associated with an increase in decline of higher risk kidneys, suggesting its labelling effect. Strategies to improve the efficiency of allocation and appropriate utilisation of these kidneys are warranted.
I’m currently a 3rd year Nephrology Advanced trainee at Monash Health and had completed my second year of training at Eastern Health. I have an interest in renal immunobiology and transplant medicine. Prior to MBBS I had completed a Bachelor of Radiography and Medical Imaging degree through Monash University.