Early Transplant Outcomes and Kidney Donor Profile Index Risk Prediction Performance in Kidneys Recovered Using a Uniform Abdominal Normothermic Regional Perfusion Technique
Motaz A. Selim, Michelle Buff, Michael Fenlon, Austin Forbes, Chinedu Nwaduru, Leonardo Aviles Ovalle, Rebecca Kohler, Joshua J. Horns, Jean Botha, Michael A. ZimmermanABSTRACT
Background
Abdominal normothermic regional perfusion (aNRP) may mitigate ischemic injury in donation after circulatory death (DCD). Specific aNRP‐DCD kidney transplant (KTx) outcomes are inadequately defined. Kidney Donor Profile Index (KDPI) assigns equivalent DCD risk components to all DCD kidneys and may not capture procurement‐related differences.
Methods
We retrospectively analyzed KTx from donors in a single donation service area procured between January 2023‐December 2024. DCD‐restricted multivariable logistic and Cox models compared aNRP‐DCD with super‐rapid recovery (SRR)‐DCD and evaluated KDPI associations with delayed graft function (DGF) and 1‐year overall graft survival.
Results
523 KTx (310 from brain‐dead donors (BDD), 122 from SRR‐DCD, 91 from aNRP‐DCD). aNRP‐DCD kidneys came from older, higher‐KDPI donors than SRR‐DCD and BDD (Age 55 vs 43.5 vs 38 years; p = 0.01, p < 0.001; KDPI 66% vs 53% vs 27%; p = 0.008, p < 0.001). In DCD‐restricted multivariable analysis, aNRP was associated with lower DGF odds than SRR (OR 0.445, 95% CI 0.23‐0.861; p = 0.016). KDPI was associated with DGF (OR 1.028, 95% CI 1.014‐1.042; p < 0.001). One‐year overall graft survival was similar. KDPI interaction modeling suggested lower DGF odds at comparable KDPI values, however the KDPI × donor‐type interaction was not statistically significant.
Conclusions
In this uniform cohort, aNRP had lower DGF odds than SRR despite higher risk. KDPI‐DGF interaction patterns were concordant in SRR‐DCD kidneys but less clear in aNRP‐DCD; however, formal interaction was not significant. These findings suggest that aNRP‐DCD may modify early graft risk; however, larger studies with longer follow‐up are needed to determine whether aNRP‐DCD affects longer‐term outcomes or KDPI performance.