대한신장학회

논문분류	춘계학술대회 초록집
제목	A New risk stratification score for deceased donor kidneys in Korea
저자	Tai Yeon Koo1, Miyeon Han2, Joongyup Lee3, Curie Ahn4, Jaeseok Yang1, KOTRY Study Group5
출판정보	2018; 2018(1):
키워드	Expanded Criteria Donor \| Deceased kidney transplantation \| Kidney Donor Risk Index \| Kidney Donor Profile Index
초록	Objectives: Organ shortages have led to expansions in the criteria for deceased donors. Although the expanded criteria donor(ECD)/standard criteria donor(SCD) dichotomous criteria have been useful for making decisions about accepting organ offers, several studies reported that these criteria are too simple to predict prognosis sufficiently. Kidney Donor Profile Index(KDPI), as an alternative to ECD/SCD in the US, may not have similar prognostic values in other countries. Here, we developed a Korean risk stratification score for deceased donor kidney using data obtained from the KONOS and KOTRY and investigated its prognostic values. Methods: We analyzed 5,524 first-time, deceased donor adult kidney transplants between 2000 and 2016. A Cox regression model was used to find out independent risk factors among donor and transplant-related factors for graft failure, adjusted for recipient characteristics. There were 426 deaths and 483 graft loss during median follow-up of 49 months. Results: A New Korean Kidney Donor Risk Index(K-KDRI) includes 6 donor and transplant factors, each found to be independently associated with graft failure: donor age, weight, history of diabetes, serum creatinine, cerebrovascular cause of death, and HLA mismatch. Median K-KDRI was 1.5. A New Korean Kidney Donor Profile Index(K-KDPI) is a remapping of the K-KDRI onto a cumulative percentage scale. The lowest K-KDPI group (<20%) showed better graft survival than the higher K-KDPI groups (20-80%, ≥80%, respectively) (p<0.001). Even within the ECD group, higher K-KDPI values were significantly associated with lower graft survival rate. In contrast, in the same K-KDPI group, there was no difference in graft survival rate between ECD and SCD. These data suggested that K-KDPI is a better prognostic tool for graft outcomes than the previous ECD/SCD criteria. Conclusions: The new K-KDPI criteria based on the Korean data are expected to give better information about graft prognosis and assist decision making for deceased donor kidney utilization in Korea.
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