Rao Panduranga S, Schaubel Douglas E, Guidinger Mary K, Andreoni Kenneth A, Wolfe Robert A, Merion Robert M, Port Friedrich K, Sung Randall S
Department of Medicine, University of Michigan HealthSystem, Ann Arbor, MI 48109-0725, USA.
Transplantation. 2009 Jul 27;88(2):231-6. doi: 10.1097/TP.0b013e3181ac620b.
We propose a continuous kidney donor risk index (KDRI) for deceased donor kidneys, combining donor and transplant variables to quantify graft failure risk.
By using national data from 1995 to 2005, we analyzed 69,440 first-time, kidney-only, deceased donor adult transplants. Cox regression was used to model the risk of death or graft loss, based on donor and transplant factors, adjusting for recipient factors. The proposed KDRI includes 14 donor and transplant factors, each found to be independently associated with graft failure or death: donor age, race, history of hypertension, history of diabetes, serum creatinine, cerebrovascular cause of death, height, weight, donation after cardiac death, hepatitis C virus status, human leukocyte antigen-B and DR mismatch, cold ischemia time, and double or en bloc transplant. The KDRI reflects the rate of graft failure relative to that of a healthy 40-year-old donor.
Transplants of kidneys in the highest KDRI quintile (>1.45) had an adjusted 5-year graft survival of 63%, compared with 82% and 79% in the two lowest KDRI quintiles (<0.79 and 0.79-<0.96, respectively). There is a considerable overlap in the KDRI distribution by expanded and nonexpanded criteria donor classification.
The graded impact of KDRI on graft outcome makes it a useful decision-making tool at the time of the deceased donor kidney offer.
我们提出了一种针对已故供体肾脏的连续肾脏供体风险指数（KDRI），它结合了供体和移植变量来量化移植失败风险。
利用1995年至2005年的全国数据，我们分析了69440例首次、仅肾脏、已故供体成人移植病例。基于供体和移植因素，并对受者因素进行校正，采用Cox回归模型来模拟死亡或移植失败的风险。所提出的KDRI包括14个供体和移植因素，每一个因素都被发现与移植失败或死亡独立相关：供体年龄、种族、高血压病史、糖尿病病史血清肌酐、脑血管疾病死亡原因、身高、体重、心脏死亡后捐赠、丙型肝炎病毒状态、人类白细胞抗原B和DR错配、冷缺血时间以及双肾或整块移植。KDRI反映了相对于健康40岁供体的移植失败率。
KDRI最高五分位数（>1.45）的肾脏移植，校正后的5年移植存活率为63%，而两个最低KDRI五分位数（分别<0.79和0.79至<0.96）的移植存活率分别为82%和79%。根据扩大标准供体分类和非扩大标准供体分类，KDRI分布存在相当大的重叠。
KDRI对移植结果的分级影响使其成为已故供体肾脏分配时有用的决策工具。
