Abstract: TH-PO1125
Development of Donor Kidney Age: A Simple Score Summarising Deceased Donor Risk
Session Information
- Transplantation: Clinical - Predictors of Outcomes - Biomarkers and Beyond
November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 1902 Transplantation: Clinical
Authors
- Morganti, Emma C., Imperial College Healthcare, London, United Kingdom
- Bright, Rupert Benjamin Graham, Imperial College Healthcare NHS Trust, London, LOndon, United Kingdom
- Adwaney, Anamika, Hammersmith Hospital, London, United Kingdom
- Dosani, Dhriti, Imperial College Healthcare NHS Trust, London, LOndon, United Kingdom
- Ashby, Damien, Imperial College, London, United Kingdom
Background
Although a number of donor factors are known to affect outcome following deceased donor kidney transplantation, many units have no clear criteria for acceptance. Donor quality scoring systems such as KDRI are based on historic data sets, performing less well in the modern comorbid donor pool, and are difficult for patients to understand.
Methods
All deceased-donor kidney offers at a single centre were analysed over a 12 month period in order to develop a patient-friendly scoring system. Donor age is modified according to the presence or absence of a number of risk factors to generate a "donor kidney age" to predict post-transplant outcome.
Results
Out of 388 offers, from 301 donors aged 6 - 84, 109 (28%) were acepted and transplanted. At 3 months post-tranplantation, recipient GFR over 30 was seen in 80%. Organs were declined due to recipient factors in 26% and donor quality concerns in 46%.
Donor Kidney Age was derived incorporating 12 risk factors: donor cardiac death, hypertension, diabetes, vascular disease, baseline kidney function, creatinine rise, oliguria, proteinuria, HLA match, cardiac arrest, use of adrenaline, and duration of hospitalisation before donation.
Quintiles of donor risk for all offers were identified using DKA cutoffs: 50, 60, 70, and 80.
Increasing DKA quintile was associated with poorer post transplant outcome, with low 3 month GFR (below 30ml/min) in 97, 85, 73, 81 and 38% of patients respectively (p<0.001). In those with functioning grafts (N=105), GFR at 3 months was strongly correlated with DKA (R=0.430, p<0.001) and was seen to reduce across increasing DKA quintiles (61, 52, 42, 41, and 29ml/min).
Conclusion
DKA is a simple score based on donor age, adjusted for 12 donor-related risk factors, which strongly predicts post-transplant outcome and is conceptually easy for patients to understand. Prospective evaluation of its influence on deceased donor acceptance decisions will be undertaken.