TY - JOUR
T1 - Changes in Discard Rate After the Introduction of the Kidney Donor Profile Index (KDPI)
AU - Bae, S.
AU - Massie, A. B.
AU - Luo, X.
AU - Anjum, S.
AU - Desai, N. M.
AU - Segev, D. L.
N1 - Funding Information:
Dr. Segev is supported by grant number K24DK101828 from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The analyses described here are the responsibility of the authors alone and do not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products or organizations imply endorsement by the U.S. Government.
Publisher Copyright:
© Copyright 2016 The American Society of Transplantation and the American Society of Transplant Surgeons
PY - 2016/7/1
Y1 - 2016/7/1
N2 - Since March 26, 2012, the Kidney Donor Profile Index (KDPI) has been provided with all deceased-donor kidney offers, with the goal of improving the expanded criteria donor (ECD) indicator. Although an improved risk index may facilitate identification and transplantation of marginal yet viable kidneys, a granular percentile system may reduce provider–patient communication flexibility, paradoxically leading to more discards (“labeling effect”). We studied the discard rates of the kidneys recovered for transplantation between March 26, 2010 and March 25, 2012 (“ECD era,” N = 28 636) and March 26, 2012 and March 25, 2014 (“KDPI era,” N = 29 021) using Scientific Registry of Transplant Recipients (SRTR) data. There was no significant change in discard rate from ECD era (18.1%) to KDPI era (18.3%) among the entire population (adjusted odds ratio [aOR] = 0.971.041.10, p = 0.3), or in any KDPI stratum. However, among kidneys in which ECD and KDPI indicators were discordant, “high risk” standard criteria donor (SCD) kidneys (with KDPI > 85) were at increased risk of discard in the KDPI era (aOR = 1.071.421.89, p = 0.02). Yet, recipients of these kidneys were at much lower risk of death (adjusted Risk Ratio [aRR] = 0.560.770.94 at 2 years posttransplant) compared to those remaining on dialysis waiting for low-KDPI kidneys. Our findings suggest that there might be an unexpected, harmful labeling effect of reporting a high KDPI for SCD kidneys, without the expected advantage of providing a more granular risk index.
AB - Since March 26, 2012, the Kidney Donor Profile Index (KDPI) has been provided with all deceased-donor kidney offers, with the goal of improving the expanded criteria donor (ECD) indicator. Although an improved risk index may facilitate identification and transplantation of marginal yet viable kidneys, a granular percentile system may reduce provider–patient communication flexibility, paradoxically leading to more discards (“labeling effect”). We studied the discard rates of the kidneys recovered for transplantation between March 26, 2010 and March 25, 2012 (“ECD era,” N = 28 636) and March 26, 2012 and March 25, 2014 (“KDPI era,” N = 29 021) using Scientific Registry of Transplant Recipients (SRTR) data. There was no significant change in discard rate from ECD era (18.1%) to KDPI era (18.3%) among the entire population (adjusted odds ratio [aOR] = 0.971.041.10, p = 0.3), or in any KDPI stratum. However, among kidneys in which ECD and KDPI indicators were discordant, “high risk” standard criteria donor (SCD) kidneys (with KDPI > 85) were at increased risk of discard in the KDPI era (aOR = 1.071.421.89, p = 0.02). Yet, recipients of these kidneys were at much lower risk of death (adjusted Risk Ratio [aRR] = 0.560.770.94 at 2 years posttransplant) compared to those remaining on dialysis waiting for low-KDPI kidneys. Our findings suggest that there might be an unexpected, harmful labeling effect of reporting a high KDPI for SCD kidneys, without the expected advantage of providing a more granular risk index.
KW - clinical decision-making
KW - clinical research/practice
KW - kidney transplantation/nephrology
KW - organ acceptance
KW - organ procurement and allocation
KW - patient education
UR - http://www.scopus.com/inward/record.url?scp=84976479589&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84976479589&partnerID=8YFLogxK
U2 - 10.1111/ajt.13769
DO - 10.1111/ajt.13769
M3 - Article
C2 - 26932575
AN - SCOPUS:84976479589
SN - 1600-6135
VL - 16
SP - 2202
EP - 2207
JO - American Journal of Transplantation
JF - American Journal of Transplantation
IS - 7
ER -