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Kidney Week

Abstract: PO2413

Could Individually Measured Creatinine Clearances Decrease the Discard Rate of High Kidney Donor Profile Index (86-100) Deceased Donor Kidneys?

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Khan, Adnan A., University of California San Diego, La Jolla, California, United States
  • Steiner, Robert W., University of California San Diego, La Jolla, California, United States
  • Turner, Hannah L., University of California San Diego, La Jolla, California, United States
  • Wainaina, Charles K., University of California San Diego, La Jolla, California, United States
  • Hahn, Ashley S., University of California San Diego, La Jolla, California, United States
Background

The Kidney Donor Profile Index (KDPI) guides center acceptance and allocation of deceased donor kidneys (DDKs). It uses donor factors such as serum creatinine (sCr), diabetes mellitus and hypertension to predict organ quality and corresponsing longivity. Due to this higher KDPI kidneys are often discarded. KDPI offers “only moderate predictability” of long-term transplant function with a c statistic of 0.6.

Methods

As an unexplored, but direct measure of deceased donor kidney quality, we determined pre-recovery creatinine clearances (CrCls) in 260 deceased donor candidates (1/2015 -12/2018) using ICU urine collections (Ucolls) and pre- and post- collection serum creatinine (sCr) values. We used CrCl > 80 ml/min as the threshold of interest, as that defines acceptable kidney function for living kidney donor candidates. Donor creatinine production rates were calculated to assess the veracity of CrCls. Organ match sequence was reviewed for all denials and UNOS denial codes and corresponding reasons for denial were reviewed.

Results

Of the 134 kidneys available from 67 high KDPI donors, 32/67 donors had both kidneys transplanted, 7/67 donors had one kidney transplanted and 28/67 donors were not transplanted. Reviewing the 35/67 donors in whom either one or both kidneys were not transplanted; 10 of them had CrCl > 80. This amounts to about 28.6 % (10/35) of the non-transplanted donors with high KDPI; having a CrCl >80 ml/min. In the high KDPI group 28/67 candidates (~42%) had measured CrCl >80 ml/min. In the KDPI 21-85 group, 97/155 (63%) of donors had CrCls that >80 ml/min; while 42/50 (84%) in the KDPI 0-20 group had measured CrCls > 80 ml/min.
Lower CrCls did not correlate with higher KDPIs within each subcohort. Donor creatinine production rates were 17.9 +/- 9.1 mg/kg/day, within population expectations.
UNOS denial codes for high KDPI organ offers were mostly 830 - donor age or quality or 837 - organ specific donor issue

Conclusion

Our data suggests that about 28.6% of the non-transplanted high KDPI donors had CrCl >80 and these kidneys could have been potentially used and not discarded. Direct measurement of CrCl in deceased kidney donors is not difficult and deserves further study, as it may improve estimates of donor kidney quality and reduce inappropriate discards in a heterogeneous group.

Funding

  • Clinical Revenue Support