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The living kidney donor profile index fails to discriminate allograft survival: implications for its use in kidney paired donation programs

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dc.contributor.authorIrish, G.
dc.contributor.authorMcMichael, L.
dc.contributor.authorKadatz, M.
dc.contributor.authorBoudville, N.
dc.contributor.authorCampbell, S.
dc.contributor.authorChadban, S.
dc.contributor.authorChang, D.
dc.contributor.authorKanellis, J.
dc.contributor.authorSharples, E.
dc.contributor.authorGill, J.
dc.contributor.authorClayton, P.
dc.date.issued2023
dc.descriptionPublished online: December 05, 2022
dc.description.abstractThe inclusion of blood group– and human leukocyte antigen–compatible donor and recipient pairs (CPs) in kidney paired donation (KPD) programs is a novel strategy to increase living donor (LD) transplantation. Transplantation from a donor with a better Living Donor Kidney Profile Index (LKDPI) may encourage CP participation in KPD programs. We undertook parallel analyses using data from the Scientific Registry of Transplant Recipients and the Australia and New Zealand Dialysis and Transplant Registry to determine whether the LKDPI discriminates death-censored graft survival (DCGS) between LDs. Discrimination was assessed by the following: (1) the change in the Harrell C statistic with the sequential addition of variables in the LKDPI equation to reference models that included only recipient factors and (2) whether the LKDPI discriminated DCGS among pairs of prognosis-matched LD recipients. The addition of the LKDPI to reference models based on recipient variables increased the C statistic by only 0.02. Among prognosis-matched pairs, the C statistic in Cox models to determine the association of the LKDPI with DCGS was no better than chance alone (0.51 in the Scientific Registry of Transplant Recipient and 0.54 in the Australia and New Zealand Dialysis and Transplant Registry cohorts). We conclude that the LKDPI does not discriminate DCGS and should not be used to promote CP participation in KPD programs.
dc.description.statementofresponsibilityGeorgina L. Irish, Lachlan C. McMichael, Matthew Kadatz, Neil Boudville, Scott Campbell, Steven Chadban, Doris Chang, John Kanellis, Edward Sharples, John S. Gill, Philip A. Clayton
dc.identifier.citationAmerican Journal of Transplantation, 2023; 23(2):232-238
dc.identifier.doi10.1016/j.ajt.2022.10.001
dc.identifier.issn1600-6135
dc.identifier.issn1600-6143
dc.identifier.orcidIrish, G. [0000-0003-0758-1867]
dc.identifier.orcidMcMichael, L. [0000-0002-1884-0329]
dc.identifier.orcidClayton, P. [0000-0001-9190-6753]
dc.identifier.urihttps://hdl.handle.net/2440/138863
dc.language.isoen
dc.publisherElsevier
dc.rights© 2022 American Society of Transplantation & American Society of Transplant Surgeons. Published by Elsevier Inc. All rights reserved.
dc.source.urihttps://doi.org/10.1016/j.ajt.2022.10.001
dc.subjectHealth services and outcomes research; Clinical research/practice; Kidney transplantation/nephrology; Organ procurement and allocation; Clinical decision making; Donors and donation; Donors and donation: paired exchange; Statistics
dc.subject.meshKidney
dc.subject.meshHumans
dc.subject.meshTissue and Organ Harvesting
dc.subject.meshKidney Transplantation
dc.subject.meshGraft Survival
dc.subject.meshLiving Donors
dc.subject.meshTissue and Organ Procurement
dc.subject.meshAllografts
dc.titleThe living kidney donor profile index fails to discriminate allograft survival: implications for its use in kidney paired donation programs
dc.typeJournal article
pubs.publication-statusPublished

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