n
e
o
l
o
g
i
a.
2
0
1
8;3
8(6):587–595
Re is a
de
la
Sociedad
Española
de
Ne ología
w
w
w. e is ane ologia.com
O iginal
a icle
Does
he
Kidney
Dono
P ofile
Index
(KDPI)
p edic
g a
and
pa ien
su i al
in
a
Spanish
popula ion?夽
Jo ge
Cal illo-A bizua,b,∗,
Miguel
A.
Pé ez-Valdi iac,
Miguel
A.
Gen il-Go an esc,
Pablo
Cas o-de-la-Nuezd,
Auxiliado a
Mazuecos-Blancae,
Albe o
Rod íguez-Beno ,
Ma ía
C.
G acia-Guindog,
F ancisco
Bo ego-U ielh,
Me cedes
Cabello-Díazi,
Ra ael
Bedoya-Pé ezj,
Manuel
Alonso-Gild,
Me cedes
Salguei a-Lazoa,b,k,
Lau a
M.
Roa-Rome oa,b
aG upo
de
Ingenie ía
Biomédica,
Uni e sidad
de
Se illa,
Se illa,
Spain
bCen o
de
In es igación
Biomédica
en
Red
en
Bioingenie ía,
Bioma e iales
y
Nanomedicina
(CIBER-BBN),
Spain
cHospi al
Uni e si a io
Vi gen
del
Rocío,
Se illa,
Spain
dCoo dinación
Au onómica
de
T asplan e
de
Andalucía,
Se illa,
Spain
eHospi al
Pue a
del
Ma ,
Cádiz,
Spain
Hospi al
Reina
So ía,
Có doba,
Spain
gHospi al
Vi gen
de
las
Nie es,
G anada,
Spain
hHospi al
de
Jaén,
Jaén,
Spain
iHospi al
Regional
de
Málaga,
Málaga,
Spain
jHospi al
In an il
Vi gen
del
Rocío,
Se illa,
Spain
kHospi al
Uni e si a io
Vi gen
Maca ena,
Se illa,
Spain
a
i
c
l
e
i
n
o
A icle
his o y:
Recei ed
7
No embe
2017
Accep ed
16
June
2018
A ailable
online
27
No embe
2018
Keywo ds:
Kidney
ansplan a ion
G a
su i al
Su i al
analysis
KDPI
a
b
s
a
c
Backg ound
and
objec i e:
The
Kidney
Dono
P ofile
Index
(KDPI),
oge he
wi h
o he
dono
and
ecipien
a iables,
can
op imise
he
o gan
alloca ion
p ocess.
This
s udy
aims
o
check
he
easibili y
o
he
KDPI
o
a
Spanish
popula ion
and
i s
p edic i e
abili y
o
g a
and
pa ien
su i al.
Ma e ials
and
me hods:
Da a
om
2734
kidney
ansplan s
ca ied
ou
in
Andalusia
be ween
Janua y
2006
and
Decembe
2015
we e
s udied.
Cases
we e
g ouped
by
ecipien
age,
ca e-
go ised
by
KDPI
qua ile
and
bo h
g a
and
pa ien
su i al
we e
compa ed
among
g oups.
Resul s:
The
KDPI
accu a ely
disc imina ed
op imal
o gans
om
subop imal
o
ma ginal
ones.
Fo
adul
ecipien s
(aged:
18–59
yea s)
i
p esen s
a
haza d
a io
o
1.013
(P
<
0.001)
o
dea h-censo ed
g a
su i al
and
o
1.013
(P
=
0.007)
o
pa ien
su i al.
Fo
elde ly
ecipien s
(aged:
60+
yea s),
KDPI
p esen ed
a
haza d
a io
o
1.016
(P
=
0.001)
o
dea h-
censo ed
g a
su i al
and
o
1.011
(P
=
0.0007)
o
pa ien
su i al.
A
mul i a ia e
analysis
iden ified
he
KDPI,
dono
age,
dona ion
a e
ci cula o y
dea h,
ecipien
age
and
gende
as
p edic i e
ac o s
o
g a
su i al.
DOI
o
o iginal
a icle:
h ps://doi.o g/10.1016/j.ne o.2018.06.009.
夽Please
ci e
his
a icle
as:
Cal illo-A bizu
J,
Pé ez-Valdi ia
MA,
Gen il-Go an es
MA,
Cas o-de-la-Nuez
P,
Mazuecos-Blanca
A,
Rod íguez-Beno
A,
e
al.
¿P edice
el
Kidney
Dono
P ofile
Index
(KDPI)
la
supe i encia
del
inje o
y
del
pacien e
en
una
población
espa ˜
nola?.
Ne ologia.
2018;38:587–595.
∗Co esponding
au ho .
E-mail
add ess:
jo [email p o ec ed]
(J.
Cal illo-A bizu).
2013-2514/©
2018
Sociedad
Espa ˜
nola
de
Ne olog´
ıa.
Published
by
Else ie
Espa ˜
na,
S.L.U.
This
is
an
open
access
a icle
unde
he
CC
BY-NC-ND
license
(h p://c ea i ecommons.o g/licenses/by-nc-nd/4.0/).
588
n
e
o
l
o
g
i
a.
2
0
1
8;3
8(6):587–595
Conclusions:
The
esul s
ob ained
show
ha
he
KDPI
makes
i
possible
o
ela e
he
dono ’s
cha ac e is ics
wi h
he
g ea e
o
lesse
su i al
o
he
g a
and
he
pa ien
in
he
Spanish
popula ion.
Howe e ,
due
o
ce ain
limi a ions,
a
new
index
o
Spain
based
on
Spanish
o
Eu opean
da a
should
be
c ea ed.
In
his
s udy,
some
p edic i e
ac o s
o
g a
su i al
a e
iden ified
ha
may
se e
as
a
fi s
s ep
in
his
pa h.
©
2018
Sociedad
Espa ˜
nola
de
Ne olog´
ıa.
Published
by
Else ie
Espa ˜
na,
S.L.U.
This
is
an
open
access
a icle
unde
he
CC
BY-NC-ND
license
(h p://c ea i ecommons.o g/licenses/
by-nc-nd/4.0/).
¿P edice
el
Kidney
Dono
P ofile
Index
(KDPI)
la
supe i encia
del
inje o
y
del
pacien e
en
una
población
espa ˜
nola?
Palab as
cla e:
T asplan e
enal
Supe i encia
del
inje o
Análisis
de
supe i encia
KDPI
e
s
u
m
e
n
An eceden es
y
obje i o:
El
Kidney
Dono
P ofile
Index
(KDPI),
jun o
a
o as
a iables
del
donan e
y
ecep o ,
puede
op imiza
el
p oceso
de
asignación
de
ó ganos.
Es e
es udio
iene
como
obje-
i o
comp oba
la
aplicabilidad
del
KDPI
en
una
población
espa ˜
nola,
así
como
su
capacidad
de
p edicción
de
la
supe i encia
del
inje o
y
del
pacien e.
Ma e iales
y
mé odos:
Se
es udia on
2.734
asplan es
enales
lle ados
a
cabo
en
Andalucía
en e
ene o
de
2006
y
diciemb e
de
2015.
Los
casos
se
ag upa on
po
edad
del
ecep o
y
cua il
del
KDPI
y
se
compa a on
en e
g upos
an o
la
supe i encia
del
inje o
como
la
del
pacien e.
Resul ados:
El
KDPI
disc imina
con
p ecisión
los
ó ganos
óp imos
de
los
subóp imos
o
ma ginales.
Pa a
ecep o es
en e
18
y
59
a˜
nos
p esen a
un
haza d
a io
de
1,013
(p
<
0,001)
pa a
supe i encia
de
inje o
censu ada
pa a
mue e
y
de
1,013
(p
=
0,007)
pa a
supe i en-
cia
del
pacien e.
Pa a
ecep o es
mayo es
de
60
a˜
nos
el
haza d
a io
es
de
1,016
(p
=
0,001)
pa a
supe i encia
del
inje o
censu ada
pa a
mue e
y
de
1,011
(p
=
0,007)
pa a
supe i encia
del
pacien e.
Un
análisis
mul i a ian e
iden ificó
como
ac o es
p edic i os
de
la
supe i encia
del
inje o
el
KDPI,
la
edad
del
donan e,
la
donación
as
mue e
ci cula o ia,
la
edad
y
el
sexo
del
ecep o .
Conclusiones:
El
KDPI
pe mi e
elaciona ,
a
g andes
asgos,
las
ca ac e ís icas
del
donan e
con
la
mayo
o
meno
supe i encia
del
inje o
y
del
pacien e
en
la
población
espa ˜
nola.
No
obs an e,
debido
a
cie as
limi aciones,
con end ía
elabo a
un
índice
p opio
a
pa i
de
los
da os
espa ˜
noles
o
eu opeos.
En
es e
abajo
se
iden ifican
algunos
ac o es
p edic i os
de
la
supe i encia
del
inje o
que
pueden
se i
como
p ime
paso
en
esa
línea.
©
2018
Sociedad
Espa ˜
nola
de
Ne olog´
ıa.
Publicado
po
Else ie
Espa ˜
na,
S.L.U.
Es e
es
un
a ´
ıculo
Open
Access
bajo
la
licencia
CC
BY-NC-ND
(h p://c ea i ecommons.o g/licenses/
by-nc-nd/4.0/).
In oduc ion
End-s age
enal
disease
(ESRD)
is
an
inc easing
wo ldwide
heal h
conce n,
and
kidney
ansplan a ion
is
he
bes
ea -
men
o
su i al
and
quali y
o
li e
o
people
wi h
ESRD.1,2
The
ageing
o
dono s
(cu en ly
achie ing
a
mean
o
59.2
yea s
in
Spain3)
and
he
high
disca ding
a e
o
o gans
by
biopsy4
a e
among
he
main
obs acles
o
ansplan a ion.
Pe o ming
a
igh
assessmen
o
kidney
quali y
and
easibili y
is
a
cu -
en
challenge
o
educe
disca ding
a e
o
o gans
po en ially
alid.
The e
a e
se e al
me hods
o
assess
he
quali y
o
kidneys5
and,
o
o gan
alloca ion,
he
Kidney
Dono
Risk
Index
(KDRI)
has
acqui ed
special
ele ance.
The
KDRI
combines
14
dono
and
ansplan
ac o s
and
p o ides
an
es ima ion
o
he
ela-
i e
isk
o
g a
ailu e
a e
kidney
ansplan
om
a
deceased
dono
compa ed
o
he
e e ence
dono .6Al hough
i s
disc imina o y
powe
is
mode a e,
he
KDRI
ep esen s
a
s ep
o wa d
in
p e ansplan a ion
kidney
assessmen
and
allo-
g a
p edic ion.
A
new
alloca ion
policy
based
on
he
KDRI
was
imple-
men ed
by
he
end
o
2014
in
he
Uni ed
S a es.
Since
some
ansplan
ac o s
a e
gene ally
unknown
a
he
ime
o e
is
made,
his
policy
uses
a
new
index,
he
Kidney
Dono
P ofile
Index
(KDPI)7based
on
he
dono -only
KDRI
e sion
includ-
ing
10
dono
ac o s.
The
KDPI
is
he
nume ical
anking
o
he
o gan
o
be
e alua ed
compa ed
o
all
kidneys
eco e ed
he
p e ious
yea .
Du ing
he
alloca ion
p ocess,
he
KDPI
is
an
aid
ool
o
decide
whe he
o
accep
an
o e
o
a
deceased
dono
kidney,
o en
disca ding
o gans
wi h
KDPI
>
85%
(conside ed
high
isk
dono s).
Las
10
yea s
in
Spain,
and
conc e ely
in
Andalucía,
he
accep ance
o
a
kidney
om
an
expanded
c i e ia
dono
(ECD)8
has
p ima y
based
on
he
esul
o
p eimplan a ion
biopsy.9
Bu
biopsy
con inues
ha ing
a
con o e sial
ole
on
he
n
e
o
l
o
g
i
a.
2
0
1
8;3
8(6):587–595
589
assessmen
o
enal
g a
easibili y.
Meanwhile
some
s udies
jus i y
i s
use
specially
o
double
ansplan ,10 o he s
doub
abou
i s
p edic ion
capaci y
o
enal
unc ioning.11–13
Using
a
isk
index
(such
as
he
KDPI)
could
help
he
decision-making
in
Spain
o
ECD
cases
when
decision
depends
on
he
esul s
o
he
biopsy.
Se e al
s udies
suppo
his
hypo hesis.
Que a d
e
al.8showed
ha
he
ela-
i e
di e ences
be ween
ECD
and
s anda d
c i e ia
dono s
(SCD)
we e
lowe
in
Eu ope
han
in
No h
Ame ica,
pa -
icula ly
o
dea h-censo ed
g a
ailu e.
Ano he
s udy
concluded
ha
high-KDPI
ansplan a ion
o e s
a
be e
su i al
e sus
emaining
on
he
wai lis
o
ecipien s
olde
han
50
yea s
when
wai
ime
is
highe
han
33
mon hs.14
This
s udy
aims:
(1)
o
check
he
adequacy
o
he
KDPI
o
disc imina e
di e ences
on
g a
and
pa ien
su i al
o
Spain
ecipien s,
and
(2)
o
iden i y
p edic o
ac o s
o
g a
su i al
ha
could
con ibu e
o
c ea e
a
Spanish
o
Eu opean
index.
Ma e ials
and
me hods
A
e ospec i e
analysis
was
pe o med
on
da a
om
a
da abase
held
by
he
Regional
T ansplan
Coo dina ion
o
Andalusia
(SICATA).
Da a
we e
e ie ed
o
single
kidney
ansplan s
pe o med
be ween
Janua y
2006
and
Decembe
2015.
G a
ailu e
was
defined
by
e u n
o
ch onic
main e-
nance
dialysis.
The
final
ollow-up
da e
was
31
Decembe
2015.
S a is ical
analyses
we e
pe o med
using
SPSS
24.0
(IBM
SPSS
S a is ics
o
Windows,
Ve sion
24.0.
IBM
Co p.,
A monk,
NY,
USA).
Since
in
Spain
i
is
no
possible
o
calcula e
KDPI
as
in
US,
ou
app oach
is
o
use
he
s udy
popula ion
i sel
o
map
KDPI
om
dono
ac o s
(see
Sec ion
Discussion
o
a
com-
men
abou
his
limi a ion).
Cases
we e
anked,
ca ego ised
in
qua ile,
and
compa ed
o
g a
su i al
(dea h-censo ed
and
uncenso ed)
and
pa ien
su i al
using
Kaplan–Meie
log-
ank
su i al
analysis.
The
associa ions
be ween
he
KDPI
as
a
con inuous
a iable
and
su i al
o
g a
and
pa ien
we e
de e mined
using
Cox
Reg ession
uni a ia e
analysis.
Cases
esul ing
on
pa ien ’s
dea h
wi h
unc ioning
g a
we e
excluded
since
his
is
a
compe i i e
e en
o
g a
ailu e
and
i
may
al e
he
esul s.
Fu he mo e,
he
disc imina i e
abili y
o
he
KDPI
was
es ed
wi h
Ha ell’s
C
s a
o
Cox
models.
Cox
mul i a ia e
eg ession
was
used
o
iden i ying
p edic o
ac o s
o
g a
su i al.
Recipien
isk
ac o s
significan ly
associa ed
wi h
g a
ailu e
using
uni a iable
sc eening
a
he
le el
o
P
<
0.05
we e
included
in
he
final
mul i a iable
model.
These
we e
age,
gende ,
heigh ,
diabe es
as
p ima y
enal
disease,
ime
on
enal
eplacemen
he -
apy
(RRT),
HIV
and
HCV
s a us.
Dono
a iables
included
HLA
misma ch
and
elemen s
con o ming
KDPI.
Since
e hnici y
o
Spain
popula ion
is
highly
uni o m,
dono
and
ecipien
ace
we e
no
included.
Resul s
Demog aphics
Da a
o
3406
kidney
ansplan s
we e
e ie ed.
A
o al
o
672
cases
we e
excluded
due
o
missing
da a,
and
2734
kidney
ansplan s
we e
included
in
he
analysis.
The
demog aphics
o
he
ecipien
and
dono
coho
a e
displayed
in
Table
1.
As
he
SICATA
does
no
eco d
e hnici y,
we
classified
all
ecipi-
en s
in
ou
popula ion
as
Caucasian.
KDPI
and
g a
su i al
As
men ioned,
KDPI
was
calcula ed
by
using
he
own
s udy
popula ion,
and
cases
we e
g ouped
by
qua iles.
Fig.
1
shows
he
e olu ion
o
he
numbe
o
o gans
in
each
qua ile
o
his
popula ion
du ing
he
inclusion
pe iod.
The
numbe
o
o gans
om
he
fi s
qua ile
(i.e.,
hose
wi h
he
bes
cha ac e is-
ics)
dec eases,
meanwhile
he
numbe
o
o gans
in
he
ou h
qua ile
( he
one
wi h
he
wo s
p ognosis)
inc eases.
This
is
a
consequence
o
he
g ea e
use
and
accep ance
o
o gans
wi h,
a
p io i,
wo se
cha ac e is ics
( o
example,
om
old
dono s).
Table
2
shows
he
ecipien s
classified
acco ding
o
KDPI
qua ile
o
he
ecei ed
o gan.
In
he
compa ison
o
cha ac-
e is ics
be ween
subpopula ions
by
applying
S uden ’s
T
and
Mann–Whi ney
U
es s,
esul s
show
ha
ecipien ’s
age
is
a
cha ac e is ic
ha
influences
he
qua ile
o
he
ecei ed
g a .
Recipien s
mos
likely
o
ecei e
an
o gan
om
he
qua ile
wi h
he
wo s
p ognosis
(i.e.,
he
ou h)
a e
hose
o
mo e
ad anced
age.
On
he
o he
hand,
days
on
enal
eplacemen
he apy
influences
o
ecei e
an
o gan
om
he
hi d
o
he
ou h
qua ile.
Finally,
nei he
he
sex
no
he
BMI
o
he
ecipien
influence
he
qua ile
o
which
he
assigned
o gan
belongs.
By
analysing
kidney
g a
su i al
by
KDPI
qua ile
o
ecipien s
o
18–59
yea s,
i
is
obse ed
ha
he
KDPI
accu-
a ely
disc imina e
g a
su i al
o
dono s
wi h
he
lowes
o
highes
isk
qua iles
achie ing
di e en
le els
o
su -
i al
a
3
yea s
(93.4%,
91.4%,
87.2%,
and
85.9%)
and
5
yea s
(91.4%,
88.1%,
85.8%
and
85.9%)
(Fig.
2a).
Fig.
2
compa es
dea h-
censo ed
and
uncenso ed
g a
su i al
esul ing
in
a
sligh ly
lowe
su i al
in
he
uncenso ed
case
ac oss
qua iles,
wha
is
cohe en
wi h
he
age
ange
o
his
coho .
G a
su i al
is
ound
significan
di e en
be ween
he
fi s
qua ile
(op imal
dono s)
and
he
hi d
and
ou h
qua -
iles
(ma ginal
dono s),
bu
he e
is
no
di e ence
be ween
qua iles
o
medium
and
low
quali y
(Table
3).
Then,
i
can
be
s a ed
ha
he
KDPI,
om
a
pa icula
dono
quali y
le el,
s ops
being
use ul
o
disc imina e
g a
su i als.
Fo
his
ecipien
g oup,
a
uni a ia e
Cox
eg ession
analysis
showed
ha
KDPI,
when
analysed
as
a
con inuous
a i-
able,
was
associa ed
wi h
dea h-censo ed
g a
su i al
in
his
g oup
wi h
a
haza d
a io
o
1.013
(P
<
0.001;
95%
CI:
1.006–1.019).
590
n
e
o
l
o
g
i
a.
2
0
1
8;3
8(6):587–595
Table
1
–
Recipien
and
dono
cha ac e is ics.
Coho
cha ac e is ics
All
cases
(N
=
2734)
Age
18–59
yea s
(N
=
1821)
Age
60+
yea s
(N
=
913)
Recipien
Age
(yea s)
52.08
(12.99)
45.00
(9.70)
66.19
(4.35)
Gende
(%
male)
1725
(63.09%)
1172
(64.32%)
553
(60.57%)
BMI
(kg/m2)
27.79
(11.66)
26.51
(10.04)
30.51
(14.11)
Time
on
RRT
(days)
1535.9
(2670.1)
1664.60
(2956.38)
1279.31
(1954.10)
Dono
Age
(yea s)
51.48
(16.0)
43.11
(12.85)
67.79
(5.50)
Gende
(%male)
1671
(61.1%)
1191
(65.91%)
480
(51.78%)
BMI
(kg/m2)
27.18
(4.40)
26.77
(4.39)
27.98
(4.31)
Cause
o
dea h:
ce eb o ascula
acciden
1742
(63.72%)
1014
(56.12%)
728
(78.53%)
DCD
149
(5.45%) 111
(6.14%) 38
(4.10%)
C ea inine
le el
(mg/dL)
0.87
(0.41)
0.91
(0.45)
0.79
(0.29)
Medical
his o y
Hype ension
905
(33.1%)
420
(23.24%)
485
(52.32%)
Diabe es
298
(10.9%)
122
(6.75%)
176
(18.99%)
Hepa i is
C
17
(0.62%%)
10
(0.55%)
7
(0.76%)
T ansplan
No
1
2552
(93.34%)
1674
(91.92%)
878
(96.17%)
2
166
(6.07%)
132
(7.25%)
34
(3.72%)
3
16
(0.59%)
15
(0.82%)
1
(0.11%)
HLA
DR
misma ch
0
1415
(51.76%)
928
(50.96%)
487
(53.34%)
1
1009
(36.91%) 690
(37.89%) 319
(34.94%)
2
310
(11.34%) 203
(11.15%)
107
(11.72%)
Da a
a e
p esen ed
as
mean
(SD)
o
n
(%).
BMI,
body
mass
index;
DCD,
dono
a e
ci cula o y
dea h
(all
ca ego ies
included);
HLA,
human
leucocy e
an igen;
RRT,
enal
eplacemen
he apy.
On
he
senio
popula ion
(60+
yea s),
kidney
g a
achie es
3-yea
su i al
o
97.3%,
93.6%,
89.6%,
and
84.5%;
and
5-
yea
su i al
o
95.1%,
89.4%,
86.6%,
and
79.6%,
espec i ely
(Fig.
3a).
These
su i al
le els
a e
simila
(o
e en
highe )
o
hose
epo ed
abo e
o
he
coho
o
18–59
yea s
since
hey
e e
o
dea h-censo ed
g a
su i al.
The
uncenso ed
g a
su i al
analysis
(Fig.
3b)
shows
how
he
ecipien ’s
age
leads
o
a
significan
educ ion
o
su i al
o
all
he
qua iles.
The
KDPI
does
no
disc imina e
be ween
consecu i e
qua -
iles
in
he
g oup
o
ecipien s
olde
han
60
yea s
(Table
4).
As
occu ed
on
he
adul
popula ion,
he
highe
he
KDPI,
he
wo se
g a
su i al.
Mo eo e ,
he
KDPI
disc imina es
among
op imal
and
ma ginal
quali y
dono s
bu
no
among
medium
and
low-quali y
dono s.
Finally,
he
uni a ia e
Cox
eg ession
analysis
showed
ha
he
KDPI
was
significan ly
associa ed
wi h
dea h-censo ed
g a
ou come
wi h
a
haza d
a io
o
1.016
(P
=
0.001;
95%
CI:
1.006–1.025).
Finally,
we
analysed
he
disc imina o y
abili y
o
he
KDPI
in
Spain
by
means
o
Ha ell’s
C.
Fo
a
bina y
ou come
(g a
su i al
s.
dea h-censo ed
g a
loss),
a
C
index
o
0.5
ep esen s
a
p edic ion
no
mo e
accu a e
han
chance.
Ac oss
all
qua iles
and
o
he
whole
popula ion
(age:
18+
yea s),
he
Ha ell’s
C
o
he
KDPI
o
g a
and
pa ien
su i al
was
0.56
and
0.63,
espec i ely.
This
is
a
p edic-
i e
powe
limi ed
and
equi alen
o
he
esul s
in
he
USA
(i.e.,
C-s a is ic
=
0.62).2
350
300
250
200
150
100
50
0
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Año
Núme o de donan es
Q1
Q2
Q3
Q4
To al
Fig.
1
–
E olu ion
o
o al
numbe
o
kidneys
and
pe
qua ile
du ing
he
inclusion
pe iod
o
he
s udied
coho .
KDPI
and
pa ien
su i al
Fig.
4
shows
pa ien
su i al
o
ecipien s
o
18–59
yea s
(a)
and
60+
yea s
(b).
Fo
he
fi s
subpopula ion,
KDPI
shows
mino
disc imina ion
among
qua iles,
al hough
he
haza d
a io
o
pa ien
su i al
associa ed
o
KDPI
o
his
g oup
is
1.013
(P
=
0.007;
95%
CI:
1.004–1.023).
Fo
ecipien s
olde
han
60
yea s,
KDPI
shows
majo
di e ences
among
qua -
iles
(Fig.
4b),
and
he
haza d
a io
o
pa ien
su i al
is
1.011
(P
=
0.007;
95%
CI:
1.003–1.018).
The e o e,
KDPI
is
a
po en ial
indica o
o
pa ien
su i al
al hough
wi h
a
lowe
disc imi-
na ion
be ween
qua iles.
n
e
o
l
o
g
i
a.
2
0
1
8;3
8(6):587–595
591
Table
2
–
Recipien
cha ac e is ics
classified
by
KDPI
qua iles
o
ecei ed
o gans.
Q1
Q2
Q3
Q4
Age
(yea s)
40.48
(11.16)
43.94
(10.95)
50.64
(11.24)
60.79
(9.02)
Gende
(%
male) 228
(62.98%) 350
(64.46%)
451
(62.55%)
696
(62.82%)
BMI
(kg/m2) 24.71
(4.65) 26.03
(8.73) 26.97
(9.78)
30.38
(14.81)
Time
on
RRT
(days)
1593
(2954)
1434
(1877)
1866
(3722)
1351
(1971)
Da a
a e
p esen ed
as
mean
(SD)
o
n
(%).
BMI,
body
mass
index;
RRT,
enal
eplacemen
he apy.
Censu ada pa a mue e
Tiempo pos - ansplan e (años)
1e
cua il
1e
cua il
2º cua il
2º cua il
4º cua il
4º cua il
3e cua il
3e cua il
Tiempo pos - ansplan e (años)
Supe i encia de inje o (%)
Supe i encia de inje o (%)
No censu ada
100
90
80
70
60
50
100
90
80
70
60
50
0
2
4
6
8 10
0
2
4
6
8 10
Indi iduos en iesgo
Cua il 1
Cua il 2
Cua il 3
Cua il 4
885
Inicio
Año 2
Año 4
Año 6
Año 8
Año 10
639
258
39
674
457
172
22
543
315
104
11
377
202
64
9
189
90
28
5
0
2
5
14
ab
Fig.
2
–
Kaplan–Meie
g a
su i al
acco ding
o
KDPI
qua ile
o
ecipien s’
age
18–59
yea s:
(a)
dea h-censo ed,
(b)
uncenso ed.
Mul i a ia e
analysis
A
se
o
candida e
p edic o s
(i.e.,
a
p io i
p edic
g a
su i al)
we e
selec ed
based
on
he
li e a u e.15–17 A
uni a ia e
Cox
eg ession
analysis
was
pe o med
o
each
p edic o
o
assess
i s
ele ance
on
g a
su i al.
The
ollowing
p edic o s
ela ed
o
ecipien
and
ansplan
ac o s
we e
significan :
age,
gen-
de ,
heigh ,
HIV
s a us,
HCV
s a us,
p ima y
enal
disease,
HLA
misma ch,
and
ime
on
enal
eplacemen
he apy.
Dono
ac-
o s
we e
included
in
wo
sepa a e
ways:
as
pa
o
he
KDPI
and
as
indi idual
ac o s.
Two
Cox
p opo ional
haza ds
g a
su i al
analysis
we e
pe o med
(Table
5).
In
he
fi s
analysis
(i.e.,
dono
ac o s
included
as
KDPI,
Table
5a),
he
KDPI
was
he
mos
significan
ac o
p edic ing
g a
su i al.
Recipien
age
and
gende
a e
also
signifi-
can ly
ela ed
o
he
ansplan
ou come.
The
haza d
a io
o
ecipien
age
is
lowe
han
1
(0.983)
wha
is
cohe en
wi h
he
ype
o
analysis
pe o med,
dea h-censo ed.
Censo ing
dea hs
con e s
ecipien
age
in
a
p o ec ing
ac o
o
g a
loss,
ha
is
consis en
wi h
se e al
s udies.18
When
KDPI
dono
ac o s
a e
analysed
sepa a ely
(Table
5b),
dono
age
and
dona ion
a e
ci cula o y
dea h
s a us
a e
he
p edic ing
ac o s
o
g a
su i al
(in
addi ion
o
ecipien
age
and
gende ).
The e
was
no
e idence
o
p edic ion
by
he
o he
ac o s
wi h
he
s udy
coho .
Discussion
The
KDPI
may
mean
a
significan
imp o emen
o
decision-
making,
bu
i s
disc imina o y
powe
on
g a
su i al
is
limi ed
(Ha ell’s
C,
0.56)
and
he
easibili y
o
high-KDPI
g a s
(some imes
disca ded)
on
ecipien s
olde
han
60
yea s
is
unce ain.
Resul s
ob ained
a e
in
acco dance
wi h
hose
o
a
ecen
s udy
alida ing
dono -only
KDRI
(i.e.,
KDPI)
on
a
Du ch
popula ion
and
ob aining
a
disc imina o y
abili y
(Ha ell’s
C)
o
0.62.19
Ou
wo k
s a es
ha
KDPI
disc imina es
g a
and
pa ien
su i al
o
ecipien s
o
18–59
yea s,
wi h
di e ences
be ween
ecipien s
o
op imal
dono s
(KDPI
<
25%)
and
he
es .
Fo
ecipien s
olde
han
60
yea s,
he
KDPI
p edic ion
powe
is
equally
limi ed,
bu
e en
hen,
i
igh ly
disc imina es
be ween
he
fi s ,
he
hi d
and
he
ou h
qua iles
(i.e.,
be ween
op imal
and
ma ginal
dono s).
The
KDPI
is
also
use ul

592
n
e
o
l
o
g
i
a.
2
0
1
8;3
8(6):587–595
Table
3
–
Compa isons
o
g a
su i al
o
qua ile
pai s.
Recipien
coho :
18–59
yea s.
Qua ile
Q2
Q3
Q4
Chi-squa e
P
Chi-squa e
P
Chi-squa e
P
Q1
3.004
0.083
8.296
0.004
5.559
0.018
Q2
–
–
2.235
0.135
2.773
0.096
Q3
–
–
–
–
0.604
0.437
S a is ically
significan
P- alues
a e
shown
in
bold.
Censu ada pa a mue e
Tiempo pos - ansplan e (años) Tiempo pos - ansplan e (a
ños)
Supe i encia de inje o (%)
Supe i encia de inje o (%)
No censu ada
100
90
80
70
60
50
100
90
80
70
60
50
0
2
4
6
810
0
2
4
6
810
Indi iduos en iesgo
Inicio
Año 2
Año 4
Año 6
Año 8
Año 10
Cua il 1 76
225
364
248
143
230
168
57 41
115
149
70
27
70
82
26 7
29
31
16 0
1
5
0
Cua il 2
Cua il 3
Cua il 4
ab
Fig.
3
–
Kaplan–Meie
g a
su i al
acco ding
o
KDPI
qua ile
o
ecipien s’
age
60+
yea s:
(a)
dea h-censo ed,
(b)
uncenso ed.
o
disc imina ing
pa ien
su i al
among
qua iles.
I
is
no e-
wo hy
in
bo h
subpopula ions
he
poo
disc imina ion
abo e
he
median
( hi d
and
ou h
qua iles);
his
migh
sugges
a
lack
o
accu acy
o
he
index
om
a
ce ain
le el
o
quali y,
o
ha
o he s
cha ac e is ics
no
collec ed
by
he
index
(e.g.,
biopsy)
a e
in ol ed.
Rega ding
ecipien s
olde
han
60
yea s,
he e
is
an
asso-
cia ion
be ween
g a
su i al
and
KDPI.
Se e al
s udies
ha e
analysed
di e en
e ec s
caused
by
expanded
o
high-KDPI
dono s
acco ding
he
ecipien ’s
age,
s a ing
ha
he
influence
on
su i al
is
lowe
in
olde
ecipien s.
Ma
e
al.
s udied
i
he
use
o
SCD
o
ECD
kidneys
influences
di e en ly
on
pa ien
su i al
i
he
ecipien ’s
age
is
highe
o
lowe
han
60
yea s.20
They
analysed
3822
cases
be ween
1997
and
2009
s a ing
ha
in
younge
ecipien s
he e
was
an
excess
isk
o
all-cause
mo ali y
(adjus ed
HR
=
1.55;
95%
CI:
1.23–1.97)
and
dea h
wi h
unc ioning
g a
(adjus ed
HR
=
1.72;
95%
CI:
1.28–2.29)
a e
ansplan a ion
wi h
ECD
kidneys
compa ed
wi h
SCD
kid-
neys.
This
conclusion
could
no
be
applied
o
olde
ecipien s
(adjus ed
HR
=
1.11;
95%
CI:
0.80–1.54,
and
adjus ed
HR
=
1.30;
95%
CI:
0.89–1.89,
espec i ely).
The
au ho s
se
ha
an
excess
isk
o
all-cause
mo ali y
on
younge
ecipien s
o
an
ECD
kidney
is
caused
by
he
inc ease
o
ca dio ascula
mo ali y
associa ed
o
wo se
enal
unc ion
o
he
g a
(and
educed
GFR)
ob ained
wi h
his
kind
o
dono .
Ch onic
inflamma-
ion
and
he
s a e
o
immunosupp ession
associa ed
wi h
u aemia
lead
o
accele a ed
a he oscle osis
ha
would
jus-
i y
hese
poo
esul s.21 Ou
wo k
ag ees
since
he
su i al
o
younge
ecipien s
is
clea ly
a ec ed
by
he
KDPI
(Fig.
4a).
I
also
s eng hs
he
impo ance
o
main aining
he
p inciple
o
alloca ion
‘old
o
old’.
He nandez
e
al.
s udied
he
odds
o
dea h
and
g a
loss
ega ding
o gan
quali y
measu ed
by
KDPI,
di ided
in
fi e
ca ego ies,
among
coho s
o
ecipien s
wi h
di e en
age
anges.22 The
su i al
o
ecipien s
om
50
o
69
yea s
ecei ing
a
low-quali y
g a
is
significan ly
educed.
Howe e ,
ecipien s
om
70
o
79
yea s
ecei ing
a
e y
low-quali y
g a
had
a
lowe
dea h
isk
han
ecipien s
om
50
o
69
yea s.
Recipien s
olde
han
79
yea s
had
he
lowes
isk.
These
esul s
a e
consis en
wi h
ou
s udy
since
he
KDPI
haza d
a io
o
pa ien
su i al
is
lowe
in
he
popula ion
o e
60
yea s
(HR
=
1.011)
han
among
hose
aged
18–59
yea s
(HR
=
1.013).
A
majo
objec i e
o
he
US
alloca ion
sys em
is
o
alloca e
low-KDPI
g a s
(be e
quali y)
o
pa ien s
wi h
high
es ima ed
su i al
(based
on
he
Es ima ed
Pos
n
e
o
l
o
g
i
a.
2
0
1
8;3
8(6):587–595
593
Table
4
–
Compa isons
o
g a
su i al
o
qua ile
pai s.
Recipien
coho :
60+
yea s.
Qua ile
Q2
Q3
Q4
Chi-squa e
P
Chi-squa e
P
Chi-squa e
P
Q1
2.057
0.151
4.319
0.038
8.081
0.004
Q2
–
–
1.731
0.188
5.674
0.017
Q3
–
–
–
–
1.570
0.210
S a is ically
significan
P- alues
a e
shown
in
bold.
Table
5
–
Significan
ac o s
in
a
isk-adjus ed
Cox
p opo ional
haza ds
g a
su i al
analysis.
Adul
deceased
dono
and
adul
ecipien
pe o med
in
Spain,
Janua y
1,
2006,
o
Decembe
31,
2015.
Va iable
Ca ego y
Wi h
KDPI
(a)
Wi h
dono
cha ac e is ics
(b)
HR
(95%
CI)
P
HR
(95%
CI)
P
KDPI
Con inuous
2.217
(1.699–2.892)
<0.001
–
–
Recipien
age
(yea )
Con inuous
0.983
(0.971–0.994)
0.003
0.982
(0.970–0.994)
0.003
Recipien
gende
Female
1.00
–
1.00
–
Male
1.277
(0.976–1.669)
0.075
1.339
(1.062–1.689)
0.013
Dono
age
(yea )
Con inuous
–
–
1.025
(1.013–1.037)
<0.001
Dona ion
a e
ci cula o y
dea h
s a us
Yes
–
–
1.776
(1.03–3.062)
0.039
No
–
–
1.00
–
(a)
Haza d
a ios
a e
adjus ed
o
ac o s
in
he
able,
and
ecipien
heigh ,
HIV
and
HCV
s a us,
p ima y
enal
disease,
HLA
misma ch,
ime
on
RRT.
(b)
Haza d
a ios
a e
adjus ed
o
ac o s
e e ed
in
(a)
and
dono
ac o s:
gende ,
hype ension,
c ea inine
le el,
heigh ,
weigh ,
his o y
o
diabe es
and
hepa i is,
and
cause
o
dea h.
HR,
haza d
a io;
CI,
confidence
in e al;
HLA,
human
leucocy e
an igen.
Supe i encia de pacien e (%)
100
90
80
70
60
02468 10 024
6
810
Supe i encia de pacien e (%)
100
90
80
70
60
Tiempo pos - ansplan e (años) Tiempo pos - ansplan e (años)
Recep o es: 18-59 años
Recep o es: 60+ a
ños
Inicio
Inicio
Año Año
Año Año Año Año Año Año Año Año
2424
6810 6810
1
1
5
29
31
1627
71
82150
116
41
168
230364
248
143 70 26
7
0
225
7614
5
2
05
28
90
191377
202
65
911
104
319
545675
458
172
2239
258
639
885Cua il 1
Cua il 2
Cua il 3
Cua il 4
57
ab
Fig.
4
–
Kaplan–Meie
pa ien
su i al
acco ding
o
KDPI
qua ile:
(a)
ecipien s’
age:
18–59
yea s,
(b)
ecipien s’
age:
60+
yea s.
T ansplan
Su i al,
EPTS7).
Thus,
young
ecipien s
bene-
fi
om
he
bes -quali y
dono s.
When
a
high-KDPI
g a
is
alloca ed
o
a
senio
ecipien ,
he
dele e ious
e ec
on
pa ien
su i al
is
mani es .
Howe e ,
ou
esul s
s a e
ha
ecipien s
olde
han
60
yea s
can
also
benefi
o
ex ended
su i al
(as
Fig.
4b
shows).
Al hough
alloca ion
sys ems
in
Spain
and
US
a e
di e en ,
mo i a ion
is
alike.
The
aim
is
o
ob ain
a
longe i y
ma ching,
so
cases
o
alloca ion
o
op imal
dono s
o
olde
ecipien s
a e
uncom-
mon.
594
n
e
o
l
o
g
i
a.
2
0
1
8;3
8(6):587–595
Finally,
he e
is
a
couple
o
po en ial
limi a ions
o
his
wo k.
Fi s ly,
KDPI
is
calcula ed
by
using
he
s udy
popula-
ion
i sel .
I
would
be
mo e
app op ia e
o
use
a
e e ence
Eu opean
dono
popula ion
(as
i
is
done
in
US)
bu
he e
is
no
such
egis y
a ailable.
The
au ho s
hink
ha
i
is
be e
o
use
he
s udy
coho
i sel
o
calcula e
he
KDPI
han
using
he
comple ely
di e en
popula ion
published
by
he
US
O gan
P ocu emen
and
T ansplan a ion
Ne wo k.23
Secondly,
o
he
e ospec i e
egis y
analysis
pe o med,
some
cases
had
o
be
excluded
due
o
missing
da a.
Miss-
ing
da a
is
due
o
andom
ailu e
in
manual
egis y
on
da a
in oduc ion,
so
he e
is
no
e idence
o
sugges
his
has
a
nega i e
e ec
on
in e p e a ion.
The e o e,
he
anal-
ysis
pe o med
a e
so-called
comple e-case
analysis,
and
no
da a
impu a ion
echnique
has
been
used
o
eplace
missing
da a.
In
summa y,
his
is
one
o
he
fi s
s udies
o
alida e
he
use
o
KDPI
in
a
Spanish
coho .
Howe e ,
due
o
ce ain
limi-
a ions
on
he
KDPI
ansla ion
o
Spain,
c ea ing
a
new
index
om
Spanish
o
Eu opean
da a
would
be
ad isable.24 In
his
wo k,
some
p edic i e
ac o s
o
g a
su i al
a e
iden ified
ha
can
se e
as
a
fi s
s ep
in
his
pa h.
Al hough
i
is
co ela ed
significan y
wi h
he
g a
and
pa ien s’
su i al,
mo e
s udies
should
be
pe o med
aim-
ing
o
inc ease
he
p edic i e
powe
o
kidney
dono
sco es
o
complemen
hem
wi h
o he
da a
sou ces
ha
mean
a
eal
clinical
aid
o
p o essionals
in
p e ansplan a ion.
Inc easingly,
ecipien s
demand
wide
in o ma ion
abou
he
g a
quali y
o
ecei e,
and
he
KDPI
is
a
igh
s ep
in
ha
di ec ion.
Howe e ,
new
echnology
ends
may
b ing
ools
ha
in eg a e
in o ma ion
om
di e en
da a
sou ces
(clinical,
biological,
his ological,
.
.
.)
abou
dono s
and
ecip-
ien s
o
pe o m
su i al
es ima ions
wi h
highe
p edic i e
powe .
Conflic s
o
in e es
The
au ho s
ha e
no
conflic s
o
in e es
o
decla e.
Acknowledgemen s
This
wo k
has
been
pa ially
suppo ed
by
he
Biomedical
Enginee ing
G oup
a
Uni e si y
o
Se illa,
and
a
g an
om
he
Fondo
de
In es igación
Sani a ia
inside
p ojec
PI15/00306.
e
e
e
n
c
e
s
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Wol e
RA,
Ashby
VB,
Mil o d
EL,
Ojo
AO,
E enge
RE,
Agodoa
LY,
e
al.
Compa ison
o
mo ali y
in
all
pa ien s
on
dialysis,
pa ien s
on
dialysis
awai ing
ansplan a ion,
and
ecipien s
o
a
fi s
cada e ic
ansplan .
N
Engl
J
Med.
1999;341:
1725–30.
2.
Rao
PS,
Me ion
RM,
Ashby
VB,
Po
FK,
Wol e
RA,
Kayle
LK.
Renal
ansplan a ion
in
elde ly
pa ien s
olde
han
70
yea s
o
age:
esul s
om
he
Scien ific
Regis y
o
T ansplan
Recipien s.
T ansplan a ion.
2007;83:1069–74.
3.
SICATA.
Sis ema
de
In o mación
de
la
Coo dinación
Au onómica
de
T asplan es
de
Andalucía.
Subsis ema
de
Insuficiencia
Renal
C ónica.
In o me
2015.
2016.
4.
Wang
CJ,
We mo e
JB,
C a y
GS.
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dono
kidney
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implica ions
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E.
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MK,
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A
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quan ifica ion
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al.
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o
su i al
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C i e ia
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and
S anda d
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ansplan
ecipien s:
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I,
Buzio
C,
Zanelli
P.
The
Kidney
Dono
P ofile
Index
(KDPI)
o
ma ginal
dono s
alloca ed
by
s anda dized
p e ansplan
dono
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assessmen :
dis ibu ion
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wi h
high
KDPI
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Ha
A,
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Ha hay
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Ab
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o
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o
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o
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P ocu emen
and
T ansplan a ion
Ne wo k
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Kidney
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P ofile
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Hamidi
O,
Poo olajal
J,
Fa hadian
M,
Tapak
L.
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impo an
isk
ac o s
o
su i al
in
kidney
g a
ailu e
pa ien s
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andom
su i al
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I an
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Heal h.
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MZ,
Nguyen
DV,
Chen
Y,
Ra el
V,
S eja
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K ishnan
M,
e
al.
P edic i e
sco e
o
pos ansplan a ion
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Molmen i
EP,
Alex
A,
Rosen
L,
Alexande
M,
Nicas o
J,
Yang
J,
e
al.
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c i e ia
p edic i e
o
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ansplan a ion.
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Segall
L,
Nis o
I,
Pascual
J,
Mucsi
I,
Gui ado
L,
Higgins
R,
e
al.,
C i e ia
o
and
app op ia eness
o
enal
ansplan a ion
in
elde ly
pa ien s
wi h
end-s age
enal
disease:
a
li e a u e
e iew
and
posi ion
s a emen
on
behal
o
he
Eu opean
Renal
Associa ion-Eu opean
Dialysis
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Renal
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Heemske k
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de
Heide
JJ,
Be ge
SP,
e
al.
Valida ion
o
he
p ognos ic
Kidney
Dono
Risk
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sys em
o
deceased
dono s
o
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he
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20.
Ma
MKM,
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WH,
C aig
JC,
Russ
GR,
Chapman
JR,
Wong
G.
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among
younge
and
olde
ecipien s
o
kidney
ansplan s
om
expanded
c i e ia
dono s
compa ed
wi h
s anda d
c i e ia
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Clin
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n
e
o
l
o
g
i
a.
2
0
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21.
Be jes
MG.
Immune
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inflamma ion
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enal
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22.
He nández
RA,
Malek
SK,
Mil o d
EL,
Finlayson
SR,
Tullius
SG.
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combined
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o
dono
quali y
and
ecipien
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highe -quali y
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pa ien
and
g a
su i al.
T ansplan a ion.
2014;98:1069–76.
23.
O gan
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and
T ansplan a ion
Ne wo k
(OPTN):
KDRI
o
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