de Morais Ana Paula Aquino, Foresto Renato Demarchi, Hazin Maria Amélia Aguiar, Cassão Bianca Cristina, Tedesco-Silva Helio, Pestana José Medina, Requião-Moura Lúcio
Universidade Federal de São Paulo, Departamento de Medicina, São Paulo, SP, Brazil.
Fundação Oswaldo Ramos, Hospital do Rim, São Paulo, SP, Brazil.
J Bras Nefrol. 2025 Jul-Sep;47(3):e20240219. doi: 10.1590/2175-8239-JBN-2024-0219en.
The Kidney Donor Profile Index (KDPI) has not been previously validated in Brazil, thus this study aimed to investigate the association between the index and one-year outcomes in kidney transplant recipients (KTRs) of standard criteria donors (SCD).
Retrospective cohort analysis including 1,943 KTRs who received kidneys from SCD between 2013 and 2017. The primary outcome was composed of death, graft loss, and 1-yr-graft function <30 mL/min/1.73m2 (eGFR, CKD-EPI). Logistic regression identified variables associated with the primary outcome, while 1-yr eGFR across KDPI strata was compared using the Kruskal-Wallis test, adjusted with the Bonferroni test.
Donors were 41.0 years old, 24.9% had hypertension, 47.3% died due to cerebrovascular injury, and 48.3% had the final creatinine >1.5 mg/dL; the median of KDPI was 52%. The primary outcome occurred in 14.4% of the cases, which was associated with longer dialysis duration before transplantation (p = 0.04), CMV-related events (p = 0.03), acute rejection (p < 0.001), and KDPI strata. Compared to the 1-35% KDPI stratum, the RRs for the primary outcome were significantly higher in higher KDPI strata: 1.62 (p = 0.03) for >35-50%, 2.28 (p < 0.001) for >50-85%, and 2.23 (p = 0.01) for >85%. The 1-yr eGFR was also significantly lower in KTRs with donors in higher KDPI strata (p < 0.001).
The KDPI was independently associated with the primary outcome composed of death, graft loss, and 1-yr eGFR <30 mL/min/1.73 m2 in recipients of SCD donors. Despite not being previously validated for Brazilian donors, the KDPI was also significantly associated with 1-yr eGFR, delayed graft function, and acute rejection in those recipients.
肾脏供体特征指数（KDPI）此前在巴西尚未得到验证，因此本研究旨在调查该指数与标准标准供体（SCD）肾移植受者（KTR）一年结局之间的关联。
回顾性队列分析，纳入了1943例在2013年至2017年间接受SCD肾脏的KTR。主要结局包括死亡、移植物丢失以及1年移植物功能<30 mL/min/1.73m²（估算肾小球滤过率，CKD-EPI）。逻辑回归确定与主要结局相关的变量，同时使用Kruskal-Wallis检验比较KDPI各分层的1年估算肾小球滤过率，并进行Bonferroni检验校正。
供体年龄为41.0岁，24.9%患有高血压，47.3%因脑血管损伤死亡，48.3%的最终肌酐>1.5 mg/dL；KDPI中位数为52%。14.4%的病例出现了主要结局，这与移植前透析时间较长（p = 0.04）、巨细胞病毒相关事件（p = 0.03）、急性排斥反应（p < 0.001）以及KDPI分层有关。与KDPI 1-35%分层相比，较高KDPI分层的主要结局风险比显著更高：>35-50%为1.62（p = 0.03），>50-85%为2.28（p < 0.001），>85%为2.23（p = 0.01）。KDPI较高分层供体的KTR中，1年估算肾小球滤过率也显著更低（p < 0.001）。
KDPI与SCD供体受者中由死亡、移植物丢失和1年估算肾小球滤过率<30 mL/min/1.73 m²组成的主要结局独立相关。尽管此前未在巴西供体中得到验证，但KDPI在这些受者中也与1年估算肾小球滤过率、移植肾功能延迟和急性排斥反应显著相关。
