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KMID : 1143420180110371231
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Public Health Weekly Report
2018 Volume.11 No. 37 p.1231 ~ p.1237
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Suggestions for improvement of the expanded category of kidney transplantation donor in Korea
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Yang Jae-Seok
Koo Tae-Yeon
Lee Joong-Yub
Yoon Youn-Sook
Jung Young-Ei
Byeon Hyo-Soon
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Abstract
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Organ shortages have led to expansions in the criteria for deceased donors. Although the existing dichotomous criteria for
expanded criteria donors (ECDs)/standard criteria donors (SCDs) have been useful for making decisions regarding the
acceptance of organ offers, many studies have reported that the ECD/SCD dichotomy may not predict graft outcomes. Here, we developed a Korean risk stratification score for deceased donor kidneys. We analyzed 5,524 first-time deceased donor adult kidney transplants performed in Korea between 2000 and 2016. A new Korean Kidney Donor Risk Index (K-KDRI) includes 5 donor and transplant factors, each of which independently associated with graft failure: donor age, weight, history of diabetes, serum creatinine, and cerebrovascular cause of death. The new Kidney Donor Profile Index (K-KDPI) re-maps the K-KDRI onto a cumulative percentage scale. The lowest K-KDPI group (< 20%) exhibited better graft survival than did the higher K-KDPI groups (20-80% or ≥ 80%) (P < 0.001). Even within the ECD group, increased K-KDPI values were significantly associated with decreased graft survival rates. Conversely, there was no difference in graft survival rates between ECD and SCD kidneys with the same K-KDPI group. These data suggested that K-KDPI is a better prognostic tool for graft outcomes than were the previous ECD/SCD criteria. The new K-KDPI based on the Korean data is expected to improve graft prognosis and assist decision-making regarding deceased donor kidney utilization in Korea.
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KEYWORD
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Kidney transplantation, Tissue donors, Graft survival, Prognosis, Decision making
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