INTRODUCTION AND AIMS: Delayed graft function (DGF) is associated with impaired graft survival in kidney transplant recipients. The kidney donor profile index (KDPI) is increasingly evaluated as a prognostic tool to predict graft quality. However, there is few data that examined the contribution of DGF and donor kidney quality to impaired graft outcomes.
METHODS: This retrospective single center study included 580 adult patients who received a deceased donor kidney from 2000-2010. KDPI was calculated using OPTN data as reference and long-term outcomes (mean 8.0 years) were assessed.
RESULTS: Overall mean KDPI was 66%. Further categorization according to KDPI <35% (n=99), 35-85% (n=264) and >85% (n=217) resulted in a very high mean KDPI of 95% in the group with the highest KDPI. Due to the nature of the European Senior Program (ESP) this group showed a significantly higher recipient age (64 years compared to 47 and 48 years in the <35% and 35-85% groups, respectively). As expected, at 10 years patients living with functioning graft (71.9%, 58.5%, 31.3%) and death censored graft survival (86.7%, 76.9%, 55.6%) decreased with increasing KDPI (Fig.1 a,b). Intriguingly, rates of DGF <35%: 35.4%, 35-85%: 50.0%, >85% 53.9%) did not increase proportionally with higher KDPI. This might represent the ESP driven effect by local allocation of kidneys ≥65 years in order to lower cold ischemia time. However, DGF had a significant negative effect on long term graft survival in all KDPI categories (Fig.1 c,d). A multivariate Cox regression analysis adjusted for KDPI and cold ischemia time revealed DGF as an independent risk factor for premature graft loss (HR 1.97, p<0.001).
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