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A modified Kidney Donor Risk Index for pediatric kidney transplant recipients

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Abstract

Background

The Kidney Donor Risk Index (KDRI) by Rao et al. was developed to measure the quality of kidney allografts. While Rao’s KDRI has been found to be a robust measure of kidney allograft survival for adult kidney transplant recipients, many studies have indicated the need to create a distinct pediatric KDRI.

Methods

Our retrospective study utilized data from the United Network for Organ Sharing database. We examined 9295 deceased donor recipients’ data for age < 18 years from 1990 to 2020. We performed a multivariate Cox regression to determine the significant recipient and transplant factors impacting pediatric kidney allograft survival.

Results

Multivariate analysis found 5 donor factors to be independently associated with graft failure or recipient death: age, female sex, anoxia as the cause of death, history of cigarette use, and cold ischemia time. Using receiver operator characteristic (ROC) curve analysis and analyzing the predictive value of each KDRI at 1, 5, and 10 years, the proposed pediatric KDRI had a statistically significant and higher predictive value for pediatric recipients at 5 (0.60 versus 0.57) and 10 years (0.61 versus 0.57) than the Rao KDRI.

Conclusions

The proposed pediatric KDRI may provide a more accurate and simpler index to assess the quality of kidney allografts for pediatric recipients. However, due to the mild increase in predictive capabilities over the Rao index, the study serves as a proof of concept to develop a pediatric KDRI. Further studies should focus on increasing the index’s predictive capabilities.

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Data availability

Data utilized in this study were from the United Network for Organ sharing public database. Statistical analysis utilized Stata 17.0 (Stata Corp).

References

  1. Lim WH, Chadban S, Campbell S, Cohney S, Russ G, McDonald S (2011) A review of utility-based allocation strategies to maximize graft years of deceased donor kidneys. Nephrology (Carlton) 16:368–376

    Article  PubMed  Google Scholar 

  2. Smith JM, Biggins SW, Haselby DG, Kim WR, Wedd J, Lamb K, Thompson B, Segev DL, Gustafson S, Kandaswamy R, Stock PG, Matas AJ, Samana CJ, Sleeman EF, Stewart D, Harper A, Edwards E, Snyder JJ, Kasiske BL, Israni AK (2012) Kidney, pancreas and liver allocation and distribution in the United States. Am J Transplant 12:3191–3212

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Rao PS, Schaubel DE, Guidinger MK, Andreoni KA, Wolfe RA, Merion RM, Port FK, Sung RS (2009) A comprehensive risk quantification score for deceased donor kidneys: the Kidney Donor Risk Index. Transplantation 88:231–236

    Article  PubMed  Google Scholar 

  4. Zhong Y, Schaubel DE, Kalbfleisch JD, Ashby VB, Rao PS, Sung RS (2019) Reevaluation of the Kidney Donor Risk Index. Transplantation 10:1714–1721

    Article  Google Scholar 

  5. Clayton PA, McDonald SP, Snyder JJ, Salkowski N, Chadban SJ (2014) External validation of the estimated posttransplant survival score for allocation of deceased donor kidneys in the United States. Am J Transplant 14:1922–1926

    Article  CAS  PubMed  Google Scholar 

  6. Gupta A, Francos G, Frank AM, Shah AP (2016) KDPI score is a strong predictor of future graft function: moderate KDPI (35–85) and high KDPI (> 85) grafts yield similar graft function and survival. Clin Nephrol 86:175–182

    Article  PubMed  Google Scholar 

  7. Organ Procurement and Transplantation Network (2020) A guide to calculating and interpreting the kidney donor profile index (KDPI). https://optn.transplant.hrsa.gov/media/1512/guide_to_calculating_interpreting_kdpi.pdf. Accessed 11 March 2022

  8. Parker WF, Thistlethwaite JR, Ross LF (2016) Kidney donor profile index does not accurately predict the graft survival of pediatric deceased donor kidneys. Transplantation 100:2471–2478

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Nazarian SM, Peng AW, Duggirala B, Bittermann T, Amaral S, Levine MH (2018) The kidney allocation system does not appropriately stratify risk of pediatric donor kidneys: Implications for pediatric recipients. Am J Transplant 18:574–579

    Article  CAS  PubMed  Google Scholar 

  10. Jackson KR, Zhou S, Ruck J, Massie AB, Holscher C, Kernodle A, Glorioso J, Motter J, Neu A, Desai N, Segev DL, Garonzik-Wang J (2019) Pediatric deceased donor kidney transplant outcomes under the Kidney Allocation System. Am J Transplant 19:3079–3086

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Pencina MJ, D’Agostino RB (2015) Evaluating discrimination of risk prediction models: the C statistic. JAMA 314:1063–1064

    Article  CAS  PubMed  Google Scholar 

  12. Filiopoulos V, Boletis JN (2016) Renal transplantation with expanded criteria donors: which is the optimal immunosuppression? World J Transplant 6:103–114

    Article  PubMed  PubMed Central  Google Scholar 

  13. Harmon WE, Alexander SR, Tejani A, Stablein D (1992) The effect of donor age on graft survival in pediatric cadaver renal transplant recipients–a report of the North American Pediatric Renal Transplant Cooperative Study. Transplantation 54:232–237

    Article  CAS  PubMed  Google Scholar 

  14. Chandar J, Chen L, Defreitas M, Ciancio G, Burke G (2021) Donor considerations in pediatric kidney transplantation. Pediatr Nephrol 36:245–257

    Article  PubMed  Google Scholar 

  15. Van Arendonk KJ, Boyarsky BJ, Orandi BJ, James NT, Smith JM, Colombani PM, Segev DL (2014) National trends over 25 years in pediatric kidney transplant outcomes. Pediatrics 133:594–601

    Article  PubMed  PubMed Central  Google Scholar 

  16. Singh A, Stablein D, Tejani A (1997) Risk factors for vascular thrombosis in pediatric renal transplantation: a special report of the North American Pediatric Renal Transplant Cooperative Study. Transplantation 63:1263–1267

    Article  CAS  PubMed  Google Scholar 

  17. Lin SJ, Koford JK, Baird BC, Hurdle JF, Krikov S, Habib AN, Goldfarb-Rumyantzev AS (2005) Effect of donors’ intravenous drug use, cigarette smoking, and alcohol dependence on kidney transplant outcome. Transplantation 80:482–486

    Article  PubMed  Google Scholar 

  18. Bowring MG, Holscher CM, Zhou S, Massie AB, Garonzik-Wang J, Kucirka LM, Gentry SE, Segev DL (2018) Turn down for what? Patient outcomes associated with declining increased infectious risk kidneys. Am J Transplant 18:617–624

    Article  PubMed  Google Scholar 

  19. Kizilbash SJ, Rheault MN, Wang Q, Vock DM, Chinnakotla S, Pruett T, Chavers BM (2019) Kidney transplant outcomes associated with the use of increased risk donors in children. Am J Transplant 19:1684–1692

    Article  CAS  PubMed  Google Scholar 

  20. Parker WF, Ross LF, Richard Thistlethwaite Jr J, Gallo AE (2018) Impact of the kidney allocation system on young pediatric recipients. Clin Transplant 32:e13223

    Article  PubMed  PubMed Central  Google Scholar 

  21. Van Arendonk KJ, Garonzik Wang JM, Deshpande NA, James NT, Smith JM, Montgomery RA, Colombani PM, Segev DL (2013) Practice patterns and outcomes in retransplantation among pediatric kidney transplant recipients. Transplantation 95:1360–1368

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Department of Student Affairs, Baylor College of Medicine, Houston, TX, USA

    Ashley Montgomery, Cameron Goff, Bolatito Adeyeri, Liam D. Ferreira, Spoorthi Kamepalli & Jake Lynn

  2. Division of Abdominal Transplant, Michael E DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA

    Nhu Thao Nguyen Galvan & Abbas Rana

  3. Renal Section, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA

    Poyyapakkam R. Srivaths & Eileen D. Brewer

Authors
  1. Ashley Montgomery
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  2. Cameron Goff
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  3. Bolatito Adeyeri
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  4. Liam D. Ferreira
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  5. Spoorthi Kamepalli
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  6. Jake Lynn
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  7. Nhu Thao Nguyen Galvan
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  8. Poyyapakkam R. Srivaths
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  9. Eileen D. Brewer
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  10. Abbas Rana
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Contributions

Dr. Abbas Rana and Cameron Goff contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Ashley Montgomery. The first draft of the manuscript was written by Ashley Montgomery. All authors commented on previous versions of the manuscript and provided critical revisions for important intellectual content. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Ashley Montgomery.

Ethics declarations

Ethics approval

The study utilized deidentified patient information from the public database United Network for Organ Sharing. IRB approval was not needed for this study.

Consent to participate

Due to using deidentified patient information, patient consent and IRB approval were both waived.

Competing interests

The authors declare no competing interests.

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Montgomery, A., Goff, C., Adeyeri, B. et al. A modified Kidney Donor Risk Index for pediatric kidney transplant recipients. Pediatr Nephrol 38, 1309–1317 (2023). https://doi.org/10.1007/s00467-022-05722-y

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