Predictors of mid-term glomerular filtration rate after deceased donor renal transplantation: kidney donor profile index as a predictor of mid-term GFR

Abstract

Glomerular filtration rate (GFR) is an excellent indicator of renal function; however, it is rarely evaluated as an endpoint. We investigated donor and recipient factors for associations that might be predictive of mid-term GFR after renal transplantation. We performed a retrospective review of 828 deceased donor renal transplantations performed at Montefiore Medical Center between the years 2009-2015. Donor characteristics included KDPI, [low (<20%), medium (20-80%), high (>80%)], age, graft types [extended criteria (ECD), cardiac death (DCD), standard criteria (SCD)], CDC high risk, HCV status and cold ischemic time (CIT). Recipient factors included age at transplant, induction agent, BK status, CMV status, acute and chronic rejection, cPRA and DSA status. Primary outcome is 3-year GFR calculated via the MDRD equation. In univariate analysis, donor age, KDPI, ECD, and chronic rejection were significantly associated with changes in 3-year GFR (p<0.001). In the multivariable regression analysis, donor age, KDPI, and chronic rejection remained associated with changes in 3-year GFR (p<0.001). Acute rejection, DCD, HCV status, CIT, BK and CMV viremia, PRA, pretransplant or de novo DSA were not associated with changes in 3-year GFR (p>0.05). We conclude that donor age, KDPI, and chronic rejection are independently associated with 3-year GFR while acute rejection, DCD, HCV status, CIT, BK and CMV viremia, PRA, existing or de novo DSA were not. Based on these findings, current scoring systems may need refinement to address the prognosis of mid-term GFR.