Development of Thai Kidney Donor Profile Index (KDPI) and Estimated Post Transplant Survival (EPTS) score for predicting outcome after deceased donor kidney transplantation: Report from Thai Transplant Registry in conjunction with Thai Red Cross
Nuttasith Larpparisuth1, Supanit Nivatvongs2,3, Atiporn Ingsathit4, Kajohnsak Noppakun5, Adisorn Lumpaopong6, Natavudh Townamchai7, Cholatip Pongskul8, Yuwadee Attajarusit2, Thanom Supaporn9, Nalinee Premasathian1.
1Division of Nephrology, Department of Medicine , Faculty of Medicine Siriraj Hospital, Bangkok, Thailand; 2Organ Donation Center, Thai Red Cross, Bangkok, Thailand; 3Department of Surgery , Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand; 4Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; 5Division of Nephrology, Department of Internal Medicine, Chiang Mai University, Chiang Mai, Thailand; 6Division of Nephrology, Department of Pediatric, Faculty of Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand; 7Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand; 8Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand; 9Division of Nephrology, Department of Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
Introduction: Assessment of quality of kidney from deceased donor (kidney donor risk index; KDRI) and life expectancy of kidney transplant recipients (estimated post-transplant survival; EPTS) is useful for appropriate organ allocation. Difference in patient characteristics and transplant scheme might limit an implementation of complex prediction models developed from western countries.
Methods: For Thai KDRI, data from Thai Transplant Registry on all 2,349 first-time, kidney-only, deceased donor kidney transplants between 2001 – 2014 were analyzed. Data of 1,289 kidney donors was retrieved from database of Organ Donation Center, Thai Red Cross. For Thai EPTS, after exclusion of pediatric transplantation, 2,234 kidney transplants were also investigated. Cox regression method was used for analysis of all proposed donor factors influencing transplant outcomes and development of model.
Results: For KDRI, there were 7 factors which impact allograft outcome. KDRI = exp((0.0028 x donor age) – (0.0087 x estimated GFR calculated from best serum creatinine of donor using CKD-EPI equation) + (0.2907 x history of death from cardiovascular accident; CVA) – (0.0114 x donor height) + (0.6712 x history of DM) + (0.3730 x history of HT) + (0.1303 x history of on adrenaline)) where history of CVA, DM, HT, adrenaline are 1 if presence of each factors. Transplant the kidney from donor in the highest quintile had a 5-year graft survival of 68.2% compared with 77.4% in second highest and 83% in the two lowest quintiles (p < 0.001). The concordant statistic of our model and US KDRI for our population was 0.60 and 0.58, respectively. For EPTS, 4 factors were significant correlated with patient survival after KT comprised of higher age, lower body weight, HCV status and history of DM. EPTS = exp((0.410 x recipient age) - (0.127 x recipient weight) + (0.3638 x HCV status) + (0.2359 x history of DM)) where status of HCV and DM are 1 if presence of each factors.
Conclusion: The first simplified kidney donor risk index and estimated survival after deceased donor KT derived from Asian population was developed. Further allocation policy of kidney based on risk score matching might maximize utilization of the shortage deceased kidney.
