A Risk Index for Living Donor Kidney Transplantation

作者：Massie A B; Leanza J; Fahmy L M; Chow E K H; Desai N M; Luo X; King E A; Bowring M G; Segev D L^*

来源：American Journal of Transplantation, 2016, 16(7): 2077-2084.

DOI：10.1111/ajt.13709

• clinical research
• practice
• kidney transplantation
• nephrology
• kidney transplantation: living donor
• graft survival

Choosing between multiple living kidney donors, or evaluating offers in kidney paired donation, can be challenging because no metric currently exists for living donor quality. Furthermore, some deceased donor (DD) kidneys can result in better outcomes than some living donor kidneys, yet there is no way to compare them on the same scale. To better inform clinical decision-making, we created a living kidney donor profile index (LKDPI) on the same scale as the DD KDPI, using Cox regression and adjusting for recipient characteristics. Donor age over 50 (hazard ratio [HR] per 10years=(1.15)1.24(1.33)), elevated BMI (HR per 10 units=(1.01)1.09(1.16)), African-American race (HR=(1.15)1.25(1.37)), cigarette use (HR= (1.09)1.16(1.23)), as well as ABO incompatibility (HR= (1.03)1.27(1.58)), HLA B (HR=(1.03)1.08(1.14)) mismatches, and DR (HR=(1.04)1.09(1.15)) mismatches were associated with greater risk of graft loss after living donor transplantation (all p<0.05). Median (interquartile range) LKDPI score was 13 (1-27); 24.2% of donors had LKDPI<0 (less risk than any DD kidney), and 4.4% of donors had LKDPI>50 (more risk than the median DD kidney). The LKDPI is a useful tool for comparing living donor kidneys to each other and to deceased donor kidneys.
This study proposes a risk index for living donor kidney transplant recipients, the LKDPI, which quantifies the risk of graft loss on the same scale as the KDPI. See editorial on page 1951 from Schold and Kaplan.

• 出版日期2016-7