The association between the Kidney Donor Profile Index and one-year outcomes in Brazilian kidney transplant recipients of standard criteria donors

Introduction: The Kidney Donor Profile Index (KDPI) has not been previously validated in Brazil, thus this study aimed to investigate the association between the index and oneyear outcomes in kidney transplant recipients (KTRs) of standard criteria donors (SCD). Methods: Retrospective cohort analysis including 1,943 KTRs who received kidneys from SCD between 2013 and 2017. The primary outcome was composed of death, graft loss, and 1-yr-graft function <30 mL/ min/1.73m2 (eGFR, CKD-EPI). Logistic regression identified variables associated with the primary outcome, while 1-yr eGFR across KDPI strata was compared using the Kruskal-Wallis test, adjusted with the Bonferroni test. Results: Donors were 41.0 years old, 24.9% had hypertension, 47.3% died due to cerebrovascular injury, and 48.3% had the final creatinine >1.5 mg/dL; the median of KDPI was 52%. The primary outcome occurred in 14.4% of the cases, which was associated with longer dialysis duration before transplantation (p = 0.04), CMV-related events (p = 0.03), acute rejection (p < 0.001), and KDPI strata. Compared to the 1-35% KDPI stratum, the RRs for the primary outcome were significantly higher in higher KDPI strata: 1.62 (p = 0.03) for >35-50%, 2.28 (p < 0.001) for >50-85%, and 2.23 (p = 0.01) for >85%. The 1-yreGFR was also significantly lower in KTRs with donors in higher KDPI strata (p < 0.001). Conclusion: The KDPI was independently associated with the primary outcome composed of death, graft loss, and 1-yr eGFR <30 mL/min/1.73 m2 in recipients of SCD donors. Despite not being previously validated for Brazilian donors, the KDPI was also significantly associated with 1-yr eGFR, delayed graft function, and acute rejection in those recipients.