The Impact of Deceased Donor Kidney Risk Significantly Varies by Recipient Characteristics

Authors

  • E. L. G. Heaphy,

    1. Department of Quantitative Health Sciences, Cleveland, Clinic, Cleveland, OH
    Search for more papers by this author
  • D. A. Goldfarb,

    1. Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH
    2. Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
    Search for more papers by this author
  • E. D. Poggio,

    1. Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH
    2. Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
    Search for more papers by this author
  • L. D. Buccini,

    1. Department of Quantitative Health Sciences, Cleveland, Clinic, Cleveland, OH
    2. Digestive Disease Institute, Cleveland Clinic, Cleveland, OH
    Search for more papers by this author
  • S. M. Flechner,

    1. Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH
    2. Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
    Search for more papers by this author
  • J. D. Schold

    Corresponding author
    1. Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH
    • Department of Quantitative Health Sciences, Cleveland, Clinic, Cleveland, OH
    Search for more papers by this author

Jesse D. Schold

scholdj@ccf.org

Abstract

As of May 2012, over 92 000 patients were awaiting a solitary kidney transplant in the United States and new waitlist registrations have been rising for over a decade. The decreasing availability of donor organs makes it imperative that organ allocation be as efficient and effective as possible. We performed a retrospective cohort study of adult recipients in the United States (n = 109 392) using Scientific Registry of Transplant Recipients data. The primary aim was to evaluate the interaction of donor risk with recipient characteristics on posttransplant outcomes. Donor quality (based on kidney donor risk index [KDRI]) had significant interactions by race, primary diagnosis and age. The hazard of KDRI on overall graft loss in non-African Americans was 2.16 (95%CI 2.08-2.25) versus 1.85 (95%CI 1.75-1.95) in African Americans (p < 0.0001), 2.16 (95%CI 2.08-2.24) in nondiabetics versus 1.84 (95%CI 1.74-1.94) in diabetics (p < 0.0001), and 2.22 (95%CI 2.13-2.32) in recipients <60 years versus 1.83 (95%CI 1.74-1.92) in recipients ≥60 (p < 0.0001). The relative hazard for diabetics at KDRI = 0.5 was 1.49 but at KDRI = 2.0 the hazard was significantly attenuated to 1.17; among African Americans the respective risks were 1.50 and 1.17 and among recipients 60 and over, it was between 1.64 and 1.22. These findings are critical considerations for informed decision-making for transplant candidates.

Ancillary