Predicting Outcomes after Transplantation of Deceased Donor Kidneys of Marginal Quality within the Eurotransplant Service Area

Abstract

<b><i>Introduction:</i></b> Kidneys of marginal quality are increasingly being used to overcome the shortage of donor organs. However, accurate prediction of outcome is needed to optimize the use of these kidneys. We aimed to test the performance of a recently proposed score consisting of delayed graft function (DGF), renal function recovery (RFR), and glomerular filtration rate (GFR) &lt;30 mL/min per 1.73 m² 90 days after transplantation for risk assessment of patient and graft survival. <b><i>Material and Methods:</i></b> A total of 221 adult brain death donors with marginal kidneys transplanted into 223 recipients within Eurotransplant were included in the analysis. Multivariable Cox proportional hazards models were constructed to assess death-censored and all-cause censored graft failure and recipient mortality at 1 and 3 years. <b><i>Results:</i></b> Recipients with DGF had a higher risk of death-censored graft loss (HR, 95% CIs: 3.058 [1.195–7.825]). Recipients with a GFR &lt;30 mL/min/1.73 m² at 90 days after transplantation had a higher risk of death censored and all-cause graft failure (HR, 95% CIs: 2.122 [1.129–3.990] and 2.122 [1.129–3.990]). None of the three components of the proposed score was associated with a higher risk of mortality. <b><i>Conclusion:</i></b> DGF and estimated GFR &lt;30 mL/min/1.73 m² but not RFR at 90 days predicted graft failure after transplantation of marginal kidneys. However, no combination of these factors was able to predict short-term patient and graft survival.