Introduction:
Kidney transplantation is undeniably a life-saving treatment for patients with end-stage renal disease, requiring renal replacement therapy. However, the demand for kidneys far exceeds the available supply, leading to a significant paucity of organs. To address this shortage, Deceased Donor Renal Transplant (DDRT) programs have been established to increase the availability of kidneys for transplantation. KDPI >85%, previously designated as expanded criteria donor (ECD) kidneys, are offered to patients who have consented to accept a non-ideal renal allograft, thereby increasing access to earlier kidney transplantation.
Despite the efforts to increase organ availability, various factors affect the utilization of kidneys from DDRT donors. Understanding these factors is crucial in optimizing kidney utilization, reducing discard rates, and improving transplant outcomes.
Methods:
It was a cross-sectional observational study that analysed retrospective data from 91 DDRT patients who underwent procurement renal biopsy. Data was collected from Jan 2017 to Aug 2024. The data was collected from the state DDRT program registry. The primary objective of the study was to investigate various factors that influence the rejection or acceptance of kidneys after procurement biopsy. The specific factors which were included: Kidney Donor Profile Index (KDPI), Maryland Aggregative Pathology Index (MAPI), age, ICU stay, urine output at retrieval, cause of death, mean serum creatinine levels, presence of Diabetes Mellitus and Hypertension. Procurement kidney biopsy findings were noted in all patients undergoing kidney biopsy before transplantation.
Results:
Total DDRT donors who underwent procurement renal biopsy were 91 (accepted 11, rejected 80), with an acceptance rate of 12.1%. Males were 74 (81.3%) and females 17 (18.7%). Mean KDPI: rejected kidneys 62.61 +/- 43.28, accepted kidneys 57.0 +/- 29.98 (p-value 0.054). MAPI score: rejected kidneys 6.25 +/- 4.98 accepted kidneys 2.09 +/- 3.61 (p-value 0.02). Donor Characteristics (i) Mean age- rejected kidneys 49.51 +/- 16.20, accepted kidneys 46.27 +/- 15.06 (ii) Mean serum creatinine- rejected kidneys 2.55 +/- 2.05 mg/dl, accepted kidneys 1.97 +/- 1.18 mg/dl (p-value 2.21), (iii) ICU stay: rejected kidneys 3.7 +/- 3.14, accepted kidneys 3.45 +/- 1.86 days (p-value 1.02). (iv) urine output at retrieval rejected kidneys 67.6 +/- 43.28, accepted kidneys 72.54 +/- 29.52 ml/hour (p-value 2.34). (v) Hypertension: accepted kidneys 27.27%, rejected kidneys 42.5% (p-value 0.023). Causes of Death: Rejected kidneys- RTA 31 (38.8%), CVA 47 (58.8%), cerebral anoxia 1 (1.2%), Accepted kidneys- RTA 7 (63.6%), CVA 4 (36.4%), cerebral anoxia nil.
Overall MAPI score was low risk 57 (62.6%), intermediate 25 (27.4%) and high risk 9 (9.8%). KDPI in low-risk, intermediate and high-risk MAPI was 57.77 +/- 28.77, 68.08 +/- 21.85 and 71.22 +/- 29.61 respectively (p-value 0.002). MAPI in patients with KDPI > 85 and < 85 was 7.46 +/- 4.31 and 5.06 +/- 5.14 respectively (p-value 0.012).
Conclusions:
The acceptance rate of kidneys for transplantation was less as compared to national and international studies. MAPI score was lower in kidneys accepted after procurement biopsies and was statistically significant. There was a statistically significant association between hypertension and rejection of kidneys, a lower prevalence of hypertension was more likely to be accepted. The accepted group had: lower KDPI, mean age, ICU stay, urine output at retrieval, and serum creatinine (although not statistically significant). The most common cause of death in accepted kidneys was RTA, whereas, in rejected kidneys, was CVA. There was a statistically significant association of KDPI with MAPI. KPDI values were lower in low-risk MAPI as compared to intermediate and high-risk MAPI.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.