Analysis of Distribution of Expanded- and Standard-Criteria Donors and Complications Among Polish Recipients by Kidney Donor Risk Index Value

Abstract Introduction The approach toward transplanting kidneys from expanded-criteria donors (ECDs) in Poland is largely site-dependent. The Kidney Donor Risk Index (KDRI) allows for obtaining a more precise characteristic of ECDs and further stratification into “better” and “worse” quality grafts. Methods Comparison of the incidence of delayed graft function (DGF) and biopsy-proven acute rejection (BPAR), median of hospitalization time and median of estimated glomerular filtration rate (eGFR) at 1 year after transplantation among kidney graft recipients (n = 468), divided by donor status (ECD/standard-criteria donor [SCD]) and KDRI value (I: 0.67–1.2, II: 1.21–1.6, III: 1.61–2.0, IV: 2.01–3.48). Results ECD kidneys have been transplanted to 32.47% of recipients. There were no ECD recipients in KDRI compartment I, 16.55% in compartment II, 79.22% in compartment III, and 100% in IV. In KDRI compartment II, DGF was diagnosed in 34.9% of SCDs and 56% of ECDs ( P  = .003), BPAR occurred in 7.8% of SCDs and 16% of ECDs ( P  = .073), median hospital stay was 12 days for SCDs and ECDs ( P  = 1), and eGFR was 50.7 mL/min for SCDs and 49.4 mL/min for ECDs ( P  = .734). In KDRI compartment III, DGF was diagnosed in 43.8% of SCDs and 49.2% of ECDs ( P  = .139), BPAR occurred in 6.3% of SCDs and 31.7% of ECDs ( P  = .001), median hospital stay was 10 days for SCDs and 12 days for ECDs ( P  = .634), and eGFR was 49.5 mL/min for SCDs and 45.2 mL/min for ECDs ( P  = .382). Among ECD recipients, DGF was diagnosed in 56.0%, 49.2%, and 47.7% of patients for KDRI compartments II, III, and IV respectively ( P  = .776); BPAR occurred in 16% (compartment II), 31.7% (compartment III), and 23.1% (compartment IV) ( P  = .273); the median hospital stay was 12 days (compartment II), 12 days (compartment III), and 12.5 days (compartment IV) ( P  = 1); and eGFR was 49.5 mL/min (compartment II), 45.4 mL/min (compartment III), and 36.1 mL/min (compartment IV) ( P  = .002). Conclusion Assessment using both the ECD and KDRI systems allows for a more precise evaluation of prognosis and predicting complications among recipients.