Utility of applying quality assessment tools for kidneys With KDPI ≥80

Mona D. Doshi, Peter P. Reese, Isaac E. Hall, Bernd Schröppel, Joseph Ficek, Richard N. Formica, Francis L. Weng, Rick D. Hasz, Heather Thiessen Philbrook, Chirag Parikh

Research output: Contribution to journalArticle

Abstract

Background. Kidneys with "high" Kidney Donor Profile Index (KDPI) are often biopsied and pumped, yet frequently discarded. Methods. In thismulticenter study, we describe the characteristics and outcomes of kidneys with KDPI of 80 or greater that were procured from 338 deceased donors. We excluded donors with anatomical kidney abnormalities. Results. Donors were categorized by the number of kidneys discarded: (1) none (n = 154, 46%), (2) 1 discarded and 1 transplanted (n = 48, 14%), (3) both discarded (n = 136, 40%). Donors in group 3 were older,more often white, and had higher terminal creatinine and KDPI than group 1 (all P < 0.05). Biopsy was performed in 92% of all kidneys, and 47% were pumped. Discard was associated with biopsy findings and first hour renal resistance. Kidney injury biomarker levels (neutrophil gelatinase-associated lipocalin, IL-18, and kidney injury molecule-1measured fromdonor urine at procurement and fromperfusate soon after pump perfusion) were not different between groups. There was no significant difference in 1-year estimated glomerular filtration rate or graft failure between groups 1 and 2 (41.5 ± 18 vs 41.4 ± 22 mL/min per 1.73 m2; P = 0.97 and 9%vs 10%; P = 0.76). Conclusions. Kidneys with KDPI of 80 or greater comprise the most resource consuming fraction of our donor kidney pool and have the highest rates of discard. Our data suggest that some discarded kidneys with KDPI of 80 or greater are viable; however, current tools and urine and perfusate biomarkers to identify these viable kidneys are not satisfactory.We need bettermethods to assess viability of kidneys with high KDPI.

Original languageEnglish (US)
Pages (from-to)1125-1133
Number of pages9
JournalTransplantation
Volume101
Issue number6
DOIs
StatePublished - Jan 1 2017

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Kidney
Biomarkers
Urine
Biopsy
Infusion Pumps
Interleukin-18
Wounds and Injuries
Glomerular Filtration Rate
Creatinine
Transplants

ASJC Scopus subject areas

  • Transplantation

Cite this

Doshi, M. D., Reese, P. P., Hall, I. E., Schröppel, B., Ficek, J., Formica, R. N., ... Parikh, C. (2017). Utility of applying quality assessment tools for kidneys With KDPI ≥80. Transplantation, 101(6), 1125-1133. https://doi.org/10.1097/TP.0000000000001388

Utility of applying quality assessment tools for kidneys With KDPI ≥80. / Doshi, Mona D.; Reese, Peter P.; Hall, Isaac E.; Schröppel, Bernd; Ficek, Joseph; Formica, Richard N.; Weng, Francis L.; Hasz, Rick D.; Thiessen Philbrook, Heather; Parikh, Chirag.

In: Transplantation, Vol. 101, No. 6, 01.01.2017, p. 1125-1133.

Research output: Contribution to journalArticle

Doshi, MD, Reese, PP, Hall, IE, Schröppel, B, Ficek, J, Formica, RN, Weng, FL, Hasz, RD, Thiessen Philbrook, H & Parikh, C 2017, 'Utility of applying quality assessment tools for kidneys With KDPI ≥80', Transplantation, vol. 101, no. 6, pp. 1125-1133. https://doi.org/10.1097/TP.0000000000001388
Doshi MD, Reese PP, Hall IE, Schröppel B, Ficek J, Formica RN et al. Utility of applying quality assessment tools for kidneys With KDPI ≥80. Transplantation. 2017 Jan 1;101(6):1125-1133. https://doi.org/10.1097/TP.0000000000001388
Doshi, Mona D. ; Reese, Peter P. ; Hall, Isaac E. ; Schröppel, Bernd ; Ficek, Joseph ; Formica, Richard N. ; Weng, Francis L. ; Hasz, Rick D. ; Thiessen Philbrook, Heather ; Parikh, Chirag. / Utility of applying quality assessment tools for kidneys With KDPI ≥80. In: Transplantation. 2017 ; Vol. 101, No. 6. pp. 1125-1133.
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AU - Doshi, Mona D.

AU - Reese, Peter P.

AU - Hall, Isaac E.

AU - Schröppel, Bernd

AU - Ficek, Joseph

AU - Formica, Richard N.

AU - Weng, Francis L.

AU - Hasz, Rick D.

AU - Thiessen Philbrook, Heather

AU - Parikh, Chirag

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N2 - Background. Kidneys with "high" Kidney Donor Profile Index (KDPI) are often biopsied and pumped, yet frequently discarded. Methods. In thismulticenter study, we describe the characteristics and outcomes of kidneys with KDPI of 80 or greater that were procured from 338 deceased donors. We excluded donors with anatomical kidney abnormalities. Results. Donors were categorized by the number of kidneys discarded: (1) none (n = 154, 46%), (2) 1 discarded and 1 transplanted (n = 48, 14%), (3) both discarded (n = 136, 40%). Donors in group 3 were older,more often white, and had higher terminal creatinine and KDPI than group 1 (all P < 0.05). Biopsy was performed in 92% of all kidneys, and 47% were pumped. Discard was associated with biopsy findings and first hour renal resistance. Kidney injury biomarker levels (neutrophil gelatinase-associated lipocalin, IL-18, and kidney injury molecule-1measured fromdonor urine at procurement and fromperfusate soon after pump perfusion) were not different between groups. There was no significant difference in 1-year estimated glomerular filtration rate or graft failure between groups 1 and 2 (41.5 ± 18 vs 41.4 ± 22 mL/min per 1.73 m2; P = 0.97 and 9%vs 10%; P = 0.76). Conclusions. Kidneys with KDPI of 80 or greater comprise the most resource consuming fraction of our donor kidney pool and have the highest rates of discard. Our data suggest that some discarded kidneys with KDPI of 80 or greater are viable; however, current tools and urine and perfusate biomarkers to identify these viable kidneys are not satisfactory.We need bettermethods to assess viability of kidneys with high KDPI.

AB - Background. Kidneys with "high" Kidney Donor Profile Index (KDPI) are often biopsied and pumped, yet frequently discarded. Methods. In thismulticenter study, we describe the characteristics and outcomes of kidneys with KDPI of 80 or greater that were procured from 338 deceased donors. We excluded donors with anatomical kidney abnormalities. Results. Donors were categorized by the number of kidneys discarded: (1) none (n = 154, 46%), (2) 1 discarded and 1 transplanted (n = 48, 14%), (3) both discarded (n = 136, 40%). Donors in group 3 were older,more often white, and had higher terminal creatinine and KDPI than group 1 (all P < 0.05). Biopsy was performed in 92% of all kidneys, and 47% were pumped. Discard was associated with biopsy findings and first hour renal resistance. Kidney injury biomarker levels (neutrophil gelatinase-associated lipocalin, IL-18, and kidney injury molecule-1measured fromdonor urine at procurement and fromperfusate soon after pump perfusion) were not different between groups. There was no significant difference in 1-year estimated glomerular filtration rate or graft failure between groups 1 and 2 (41.5 ± 18 vs 41.4 ± 22 mL/min per 1.73 m2; P = 0.97 and 9%vs 10%; P = 0.76). Conclusions. Kidneys with KDPI of 80 or greater comprise the most resource consuming fraction of our donor kidney pool and have the highest rates of discard. Our data suggest that some discarded kidneys with KDPI of 80 or greater are viable; however, current tools and urine and perfusate biomarkers to identify these viable kidneys are not satisfactory.We need bettermethods to assess viability of kidneys with high KDPI.

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