INTERNATIONAL TRENDS IN ORGAN DONATION

J.K. Pine, P.J. Goldsmith, D.M. Ridgway, K. Brady, S. Pollard, M. Attia, N. Ahmad, K.V. Menon
Organ Transplantation, St James's University Hospital, Leeds/UNITED KINGDOM

Body: Introduction. Donation after cardiac death (DCD) increase the number of available grafts by expanding the donor pool beyond the conventional brainstem death donors (DBDs). The use of these marginal grafts would be enhanced by being able to estimate graft outcome based on patient factors. The Kidney Donor Risk Index (KDRI) is one method proposed to allow accurate assessment of the relative risk of graft failure based on donor and transplant variables, independent of the recipient.¹ We attempt to validate this score in a cohort of DCD grafts transplanted at St James’s University Hospital, Leeds, in order to determine its usefulness when assessing these marginal grafts. Method. Data required to produce a KDRI score was obtained from an existing database. The variables required were: donor age, donor ethnicity, donor hypertension, donor diabetes, donor serum creatinine, donor cause of death, donor height and weight, DCD, donor hepatitis C status, number of B mismatches, number of DR mismatches, cold ischemic time and whether the procedure was an en-bloc or double renal transplant. This data was then used to produce a KDRI score as described in Rao et al (2009)¹. Results. Between April 2002 and December 2009, 201 transplants utilising DCD grafts were performed at St James’s University Hospital, Leeds. Of these a complete set of variables allowing KDRI calculation was available in 184. The cohort was then divided into those with a KDRI of <1 (n=48), those with a KDRI of 1-1.5 (n=95), and those with a KDRI of >1.5 (n=41). Survival analysis revealed that both patient and graft survival was significantly reduced in the KDRI >1.5 group (p=0.04 & p=0.038) with estimated 5-year graft survival approaching 50%. A Kaplan-Meier curve for graft survival demonstrates the stratification of risk provided by the KDRI score (figure 1). Discussion. The use of DCD grafts in renal transplantation is an accepted method of expanding the donor pool. This study validates the use of the KDRI score in this cohort of patients. Graft survival for patients in the high DRI group is significantly different at 1 yr and continues to deteriorate thereafter. The KDRI is potentially a useful tool when assessing marginal DCD grafts. Figure 1. 1. Rao et al. A Comprehensive Risk Quantification Score for Deceased Donor Kidneys: The Kidney Donor Risk Index. Transplantation, 2009; 88(2):231-236.

Disclosure: All authors have declared no conflicts of interest.