Suggestions for improvement of the expanded category of kidney transplantation donor in Korea

Yang Jaeseok, Koo Taiyeon, Lee Joongyub
Seoul National University Hospital
Yoon Younsook, Jung Youngei, Byeon Hyosoon
Division of Organ Transplant Management, Center for Korean Network for Organ Sharing, KCDC

Organ shortages have led to expansions in the criteria for deceased donors. Although the existing dichotomous criteria for expanded criteria donors (ECDs)/standard criteria donors (SCDs) have been useful for making decisions regarding the acceptance of organ offers, many studies have reported that the ECD/SCD dichotomy may not predict graft outcomes. Here, we developed a Korean risk stratification score for deceased donor kidneys. We analyzed 5,524 first-time deceased donor adult kidney transplants performed in Korea between 2000 and 2016. A new Korean Kidney Donor Risk Index (K-KDRI) includes 5 donor and transplant factors, each of which independently associated with graft failure: donor age, weight, history of diabetes, serum creatinine, and cerebrovascular cause of death. The new Kidney Donor Profile Index (K-KDPI) re-maps the K-KDRI onto a cumulative percentage scale. The lowest K-KDPI group (< 20%) exhibited better graft survival than did the higher K-KDPI groups (20-80% or ≥ 80%) (P < 0.001). Even within the ECD group, increased K-KDPI values were significantly associated with decreased graft survival rates. Conversely, there was no difference in graft survival rates between ECD and SCD kidneys with the same K-KDPI group. These data suggested that K-KDPI is a better prognostic tool for graft outcomes than were the previous ECD/SCD criteria. The new K-KDPI based on the Korean data is expected to improve graft prognosis and assist decision-making regarding deceased donor kidney utilization in Korea.

Keywords: Kidney transplantation, Tissue donors, Graft survival, Prognosis, Decision making