Abstract: FR-PO1038
Limitation of Terminal Serum Creatinine as a KDPI Variable in Predicting Long-term Kidney Transplant Outcomes
Session Information
- Transplantation: Donor-Candidate Assessment and Predictors of Outcome
November 03, 2017 | Location: Hall H, Morial Convention Center
Abstract Time: 10:00 AM - 10:00 AM
Category: Transplantation
- 1702 Transplantation: Clinical and Translational
Authors
- Chopra, Bhavna, Allegheny General Hospital, Pittsburgh, Pennsylvania, United States
- Marcus, Richard J., Allegheny General Hospital, Pittsburgh, Pennsylvania, United States
- Sureshkumar, Kalathil K., Allegheny General Hospital, Pittsburgh, Pennsylvania, United States
Background
Terminal serum creatinine (Cr) is a varible in deriving kidney donor profile index (KDPI) which is used for deceased donor kidney (DDK) allocation and predicting transplant outcomes. Terminal Cr is a dynamic variable and can increase from reversible causes. We hypothesize that transplantation of DDKs with higher terminal Cr within a KDPI group results in better long-term outcomes since these kidneys likely undergo procurement biopsy and transplant centers generally accept these kidneys only if the biopsy shows predominantly acute tubular injury with minimal chronicity.
Methods
Using the UNOS database, we identified adult DDK transplant recipients from 2000 to 2015 who received induction and were discharged on calcineurin inhibitor and mycophenolate mofetil maintenance.Patients were divided into 4 KDPI categories (0-20%, 21-50%, 51-85% and >85%). Using a Cox model, adjusted long-term graft and patient outcomes were compared between recipients of kidneys with terminal Cr >2.0 vs. ≤2.0 mg/dL under each KDPI category.
Results
Study comprised of 59,645 patients with a median follow up of 48 months. Adjusted graft and patient outcome comparisons based on terminal Cr for different KDPI groups are shown in the table. Adjusted overall graft failure and patient death risks were lower in patients who received DDKs with termial Cr >2 vs. ≤ 2 mg/dL in KDPI 21-50% and 51-85% groups but not in best quality (KDPI 0-20%) and marginal kidney (KDPI >85%) recipients. There were no differences in death-censored graft failure risks. Lower overall graft failure and similar death-censored graft failure in recipients of DDK with terminal Cr >2.0 mg/dL indicated reduced death with functioning graft.
Conclusion
The finding of reduced risk for death with functioning graft in patients who recieved DDK with termial Cr >2 mg/dL in the mid KDPI ranges likely reflects the selective use of these kidneys when procurment biopsy findings are favorable resulting in better long-term allograft function. Our study highlights limitations of using elevated terminal Cr in derivng KDPI.
Adjusted graft and patient outcomes by terminal creatinine (Cr) under different KDPI groups
| KDPI 0-20% Cr >2; n=478; Cr≤ 2; n=14769 | KDP 21-50% Cr >2; n=1592; Cr≤2; n=17,762 | KDPI 51-85% Cr>2; n=1388; Cr≤2; n=18,024 | KDPI>85% Cr >2; n=349; Cr≤2; n=5282 | |||||
| HR (95% CI) | p | HR (95% CI) | p | HR (95% CI) | p | HR (95% CI) | p | |
| Overall graft failure risk | 0.92 (0.75-1.14) | 0.46 | 0.88 (0.77-0.99) | 0.04 | 0.86 (0.76-0.96) | 0.007 | 1.02 (0.86-1.21) | 0.85 |
| Death-censored graft failure risk | 0.91(0.68-1.23) | 0.54 | 0.89 (0.75-1.05) | 0.17 | 0.91 (0.79-1.06) | 0.22 | 1.09 (0.88-1.37) | 0.43 |
| Patient death risk | 0.88 (0.68-1.13) | 0.30 | 0.86 (0.74-0.99) | 0.04 | 0.84 (0.74-0.97) | 0.01 | 0.94 (0.76-1.16) | 0.58 |