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Kidney Week

Abstract: PO2167

Little Goes a Long Way: Is Kidney Donor Profile Index (KDPI) a Good Predictor for Pediatric Kidneys from Donors Less Than 10 kg?

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Harris, Liliia, The University of Mississippi Medical Center, Jackson, Mississippi, United States
  • Avula, Uma Mahesh R., The University of Mississippi Medical Center, Jackson, Mississippi, United States
  • Syed, Bushra, The University of Mississippi Medical Center, Jackson, Mississippi, United States
  • Vaitla, Pradeep, The University of Mississippi Medical Center, Jackson, Mississippi, United States
  • Cabeza Rivera, Franco H., The University of Mississippi Medical Center, Jackson, Mississippi, United States
Introduction

Pediatric deceased donor kidneys (DDK) constitute 10-12% of the DDK supply and are allocated using the same criteria as adult kidneys. Kidney Donor Profile Index (KDPI) is designed to predict kidney graft performance in adult recipients based on 10 donor characteristics. A KDPI scale goes from 1 (best) to 100 (worst). Most child donor kidneys classified as KDPI-C (≥35% but ≤85%) and KDPI-D (>85%) which makes them less desirable. In addition, few programs use kidneys from donors less than 1 year.

Case Description

We report a case of pediatric en bloc kidney (EBK) transplantation procured from a 7-month-old female donor, with a bodyweight of 7.7 kg. KDPI is 87%. The recipient is a 39-year-old female with a bodyweight of 54 kg and a diagnosis of ESKD secondary to biopsy-proven FSGS. The recipient had been on PD for 37 months, baseline sCr of 12-15 mg/dL and was oliguric. Cold ischemic time of the kidneys was 8 h 33 mins, warm ischemic time - 24 mins, estimated blood loss - 200 mL. Intraoperative challenges included tedious organ preparation and extremely small vessels requiring complex reconstruction along with the creation of 2 ureteral anastomoses. A postoperative complication included delayed graft function required 2 hemodialysis sessions. Thereafter graft function improved and sCr trended from 15.48 mg/dL to 1.46 mg/dL at 4 weeks follow-up.

Discussion

KDPI is a valuable tool for adult donors but takes an oversimplified approach to the pediatric donor population. KDPI calculation includes donor age, weight, and height does not lead to a proportional scaling of the hazard in pediatric donors. It leads to misclassification and underestimation of a sizable number of kidneys from small pediatric donors. In addition, although it was found en bloc to be a significant factor and shown EBK versus SKT as an important predictor for graft performance, it was decided not to include this criterion in KDPI. Pediatric EBKs had the lowest acute rejection and delayed graft function rates in comparison with SKT. Furthermore, the eGFR for pediatric EBKs improves due to the continuous growth of pediatric kidneys after transplant. In summary, modified KDPI tailored to the pediatric donors is warranted to accurately represent pediatric donor kidney survival, attract recipients and surgeons to address the problem of organ shortage.