Department of Surgery, Einstein College of Medicine, Bronx, NY.
Am J Transplant. 2013 Sep;13(9):2433-40. doi: 10.1111/ajt.12383. Epub 2013 Aug 6.
UNOS guidelines provide inadequate discriminatory criteria for kidneys that should be transplanted as single (SKT) versus dual (DKT). We evaluated the utility of the kidney donor risk index (KDRI) to define kidneys with better outcomes when transplanted as dual. Using SRTR data from 1995 to 2010 of de novo KTX recipients of adult deceased-donor kidneys, we examined outcomes of SKT and DKT stratified by KDRI group ≤1.4 (n = 49 294), 1.41-1.8 (n = 15 674), 1.81-2.2 (n = 6523) and >2.2 (n = 2791). DKT of kidneys with KDRI >2.2 was associated with significantly better overall graft survival [adjusted hazard ratio (aHR) 0.83, 95% confidence interval (CI) 0.72-0.96] compared to single kidneys with KDRI >2.2. DKT was associated with significantly decreased odds of delayed graft function (top 2 KDRI categories) and significantly decreased odds of 1-year serum creatinine level >2 mg/dL (top 3 KDRI categories). Among SKT and DKT from KDRI >2.2 there were 16.1 and 13.9 graft losses per 100 patient follow-up years, respectively. KDRI >2.2 is a useful discriminatory cut-off for the determination of graft survival benefit with the use of DKT; however, the benefit of increased graft years was less than half of single kidneys from donors in the same KDRI range.
UNOS 指南为应作为单器官（SKT）移植还是双器官（DKT）移植的肾脏提供了不足的鉴别标准。我们评估了肾脏供体风险指数（KDRI）在定义作为双器官移植时具有更好结局的肾脏方面的效用。使用 1995 年至 2010 年来自成人尸体供体肾移植受者的 SRTR 数据，我们检查了 KDRI 组≤1.4（n = 49294）、1.41-1.8（n = 15674）、1.81-2.2（n = 6523）和>2.2（n = 2791）的 SKT 和 DKT 的结果。与 KDRI >2.2 的单器官相比，KDRI >2.2 的肾脏的 DKT 与整体移植物存活率显著提高相关[调整后的危险比（aHR）0.83，95%置信区间（CI）0.72-0.96]。与 KDRI >2.2 的单器官相比，DKT 与延迟移植物功能障碍的几率显著降低（前 2 个 KDRI 类别）和 1 年血清肌酐水平>2 mg/dL 的几率显著降低（前 3 个 KDRI 类别）相关。在 KDRI >2.2 的 SKT 和 DKT 中，分别有 16.1 和 13.9 个移植物丢失，每 100 个患者随访年。KDRI >2.2 是确定 DKT 移植获益的有用鉴别截止值；然而，增加的移植物存活年数的获益不到同一 KDRI 范围内供体单器官的一半。
