A donor risk index for graft loss in pediatric living donor kidney transplantation

Heather L. Wasik; Cozumel S. Pruette; Rebecca L. Ruebner; Mara A. McAdams-DeMarco; Sheng Zhou; Alicia M. Neu; Dorry L. Segev; Allan B. Massie

doi:10.1111/ajt.15360

A donor risk index for graft loss in pediatric living donor kidney transplantation

Heather L. Wasik, Cozumel S. Pruette, Rebecca L. Ruebner, Mara A. McAdams-DeMarco, Sheng Zhou, Alicia M. Neu, Dorry L. Segev, Allan B. Massie

School of Medicine

Research output: Contribution to journal › Article › peer-review

Abstract

Pediatric kidney transplant candidates often have multiple potential living donors (LDs); no evidence-based tool exists to compare potential LDs, or to decide between marginal LDs and deceased donor (DD) kidney transplantation (KT). We developed a pediatric living kidney donor profile index (P-LKDPI) on the same scale as the DD KDPI by using Cox regression to model the risk of all-cause graft loss as a function of living donor characteristics and DD KDPI. HLA-B mismatch (adjusted hazard ratio [aHR] per mismatch = _1.041.27_1.55), HLA-DR mismatch (aHR per mismatch = _1.021.23_1.49), ABO incompatibility (aHR = _1.203.26_8.81), donor systolic blood pressure (aHR per 10 mm Hg = _1.011.07_1.18), and donor estimated GFR (eGFR; aHR per 10 mL/min/1.73 m² = _0.880.94_0.99) were associated with graft loss after LDKT. Median (interquartile range [IQR]) P-LKDPI was −25 (−56 to 12). 68% of donors had P-LKDPI <0 (less risk than any DD kidney) and 25% of donors had P-LKDPI >14 (more risk than median DD kidney among pediatric KT recipients during the study period). Strata of LDKT recipients of kidneys with higher P-LKDPI had a higher cumulative incidence of graft loss (39% at 10 years for P-LDKPI ≥20, 28% for 20> P-LKDPI ≥−20, 23% for −20 > P-LKDPI ≥−60, 19% for P-LKDPI <−60 [log rank P <.001]). The P-LKDPI can aid in organ selection for pediatric KT recipients by allowing comparison of potential LD and DD kidneys.

Original language	English (US)
Pages (from-to)	2775-2782
Number of pages	8
Journal	American Journal of Transplantation
Volume	19
Issue number	10
DOIs	https://doi.org/10.1111/ajt.15360
State	Published - Oct 1 2019

Keywords

Scientific Registry for Transplant Recipients (SRTR)
clinical research/practice
donors and donation: living
graft survival
kidney transplantation
kidney transplantation/nephrology
living donor
pediatrics

ASJC Scopus subject areas

Immunology and Allergy
Transplantation
Pharmacology (medical)

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10.1111/ajt.15360

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A donor risk index for graft loss in pediatric living donor kidney transplantation. / Wasik, Heather L.; Pruette, Cozumel S.; Ruebner, Rebecca L.; McAdams-DeMarco, Mara A.; Zhou, Sheng; Neu, Alicia M.; Segev, Dorry L.; Massie, Allan B.

In: American Journal of Transplantation, Vol. 19, No. 10, 01.10.2019, p. 2775-2782.

Research output: Contribution to journal › Article › peer-review

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title = "A donor risk index for graft loss in pediatric living donor kidney transplantation",

abstract = "Pediatric kidney transplant candidates often have multiple potential living donors (LDs); no evidence-based tool exists to compare potential LDs, or to decide between marginal LDs and deceased donor (DD) kidney transplantation (KT). We developed a pediatric living kidney donor profile index (P-LKDPI) on the same scale as the DD KDPI by using Cox regression to model the risk of all-cause graft loss as a function of living donor characteristics and DD KDPI. HLA-B mismatch (adjusted hazard ratio [aHR] per mismatch = 1.041.271.55), HLA-DR mismatch (aHR per mismatch = 1.021.231.49), ABO incompatibility (aHR = 1.203.268.81), donor systolic blood pressure (aHR per 10 mm Hg = 1.011.071.18), and donor estimated GFR (eGFR; aHR per 10 mL/min/1.73 m2 = 0.880.940.99) were associated with graft loss after LDKT. Median (interquartile range [IQR]) P-LKDPI was −25 (−56 to 12). 68% of donors had P-LKDPI <0 (less risk than any DD kidney) and 25% of donors had P-LKDPI >14 (more risk than median DD kidney among pediatric KT recipients during the study period). Strata of LDKT recipients of kidneys with higher P-LKDPI had a higher cumulative incidence of graft loss (39% at 10 years for P-LDKPI ≥20, 28% for 20> P-LKDPI ≥−20, 23% for −20 > P-LKDPI ≥−60, 19% for P-LKDPI <−60 [log rank P <.001]). The P-LKDPI can aid in organ selection for pediatric KT recipients by allowing comparison of potential LD and DD kidneys.",

keywords = "Scientific Registry for Transplant Recipients (SRTR), clinical research/practice, donors and donation: living, graft survival, kidney transplantation, kidney transplantation/nephrology, living donor, pediatrics",

author = "Wasik, {Heather L.} and Pruette, {Cozumel S.} and Ruebner, {Rebecca L.} and McAdams-DeMarco, {Mara A.} and Sheng Zhou and Neu, {Alicia M.} and Segev, {Dorry L.} and Massie, {Allan B.}",

note = "Funding Information: This work was supported by grant number T32DK007732 (Wasik), K01DK101677 (Massie), and K24DK101828 (Segev) from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The analyses described here are the responsibility of the authors alone and do not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government. The data reported here have been supplied by the Minneapolis Medical Research Foundation (MMRF) as the contractor for the Scientific Registry of Transplant Recipients (SRTR). The interpretation and reporting of these data are the responsibility of the authors and in no way should be seen as an official policy of or interpretation by the SRTR or the U.S. Government.",

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AU - Wasik, Heather L.

AU - Pruette, Cozumel S.

AU - Ruebner, Rebecca L.

AU - McAdams-DeMarco, Mara A.

AU - Zhou, Sheng

AU - Neu, Alicia M.

AU - Segev, Dorry L.

AU - Massie, Allan B.

N1 - Funding Information: This work was supported by grant number T32DK007732 (Wasik), K01DK101677 (Massie), and K24DK101828 (Segev) from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The analyses described here are the responsibility of the authors alone and do not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government. The data reported here have been supplied by the Minneapolis Medical Research Foundation (MMRF) as the contractor for the Scientific Registry of Transplant Recipients (SRTR). The interpretation and reporting of these data are the responsibility of the authors and in no way should be seen as an official policy of or interpretation by the SRTR or the U.S. Government.

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N2 - Pediatric kidney transplant candidates often have multiple potential living donors (LDs); no evidence-based tool exists to compare potential LDs, or to decide between marginal LDs and deceased donor (DD) kidney transplantation (KT). We developed a pediatric living kidney donor profile index (P-LKDPI) on the same scale as the DD KDPI by using Cox regression to model the risk of all-cause graft loss as a function of living donor characteristics and DD KDPI. HLA-B mismatch (adjusted hazard ratio [aHR] per mismatch = 1.041.271.55), HLA-DR mismatch (aHR per mismatch = 1.021.231.49), ABO incompatibility (aHR = 1.203.268.81), donor systolic blood pressure (aHR per 10 mm Hg = 1.011.071.18), and donor estimated GFR (eGFR; aHR per 10 mL/min/1.73 m2 = 0.880.940.99) were associated with graft loss after LDKT. Median (interquartile range [IQR]) P-LKDPI was −25 (−56 to 12). 68% of donors had P-LKDPI <0 (less risk than any DD kidney) and 25% of donors had P-LKDPI >14 (more risk than median DD kidney among pediatric KT recipients during the study period). Strata of LDKT recipients of kidneys with higher P-LKDPI had a higher cumulative incidence of graft loss (39% at 10 years for P-LDKPI ≥20, 28% for 20> P-LKDPI ≥−20, 23% for −20 > P-LKDPI ≥−60, 19% for P-LKDPI <−60 [log rank P <.001]). The P-LKDPI can aid in organ selection for pediatric KT recipients by allowing comparison of potential LD and DD kidneys.

AB - Pediatric kidney transplant candidates often have multiple potential living donors (LDs); no evidence-based tool exists to compare potential LDs, or to decide between marginal LDs and deceased donor (DD) kidney transplantation (KT). We developed a pediatric living kidney donor profile index (P-LKDPI) on the same scale as the DD KDPI by using Cox regression to model the risk of all-cause graft loss as a function of living donor characteristics and DD KDPI. HLA-B mismatch (adjusted hazard ratio [aHR] per mismatch = 1.041.271.55), HLA-DR mismatch (aHR per mismatch = 1.021.231.49), ABO incompatibility (aHR = 1.203.268.81), donor systolic blood pressure (aHR per 10 mm Hg = 1.011.071.18), and donor estimated GFR (eGFR; aHR per 10 mL/min/1.73 m2 = 0.880.940.99) were associated with graft loss after LDKT. Median (interquartile range [IQR]) P-LKDPI was −25 (−56 to 12). 68% of donors had P-LKDPI <0 (less risk than any DD kidney) and 25% of donors had P-LKDPI >14 (more risk than median DD kidney among pediatric KT recipients during the study period). Strata of LDKT recipients of kidneys with higher P-LKDPI had a higher cumulative incidence of graft loss (39% at 10 years for P-LDKPI ≥20, 28% for 20> P-LKDPI ≥−20, 23% for −20 > P-LKDPI ≥−60, 19% for P-LKDPI <−60 [log rank P <.001]). The P-LKDPI can aid in organ selection for pediatric KT recipients by allowing comparison of potential LD and DD kidneys.

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