Kidney transplant

The kidney donor profile index (KDPI)  is used in the new kidney allocation system to match the longevity of the kidney with that of the recipient to maximize the years of life gained through transplantation. It combines 10 donor factors into a single number that summarizes the potential risk of graft failure after kidney transplant.  It is not intended to serve as the only metric for determining donor suitability. Indeed the C-statistic for this is 0.6 , which is a little better than a coin toss. Many of the factors have no bearing on long-term function.  Pediatric en-bloc kidneys and dual kidneys from older donors will have very high KDPI even though they will work far better than a single adult kidney with KDPI<85. It is an improvement over the old system of standard criteria and extended criteria kidneys, but far from perfect.  Given the poor relationship to outcomes, I do not place much value on this in my practice. In my experience the factors ...

The new kidney allocation system was implemented in December 2014 after more than a decade of careful consideration. It was designed to maximize the years of life gained through transplantation and to reduce the discard rate for marginal kidneys. There is more sharing of kidneys outside of the local area due to regional and national priority for very highly sensitized patients, as well as the use of a combined local/regional list for more marginal kidneys. However, substantial geographic disparities continue to exist as this was not the primary goal of the new system. The new system does use dialysis start time to calculate waiting time but early referral and listing are still very important. Patients that never go on dialysis and those with shorter duration on dialysis prior to transplant have better outcomes. I am fortunate to work in the Midwest where the waiting time for organs is very short. Iowa is a flyover state but because of the very long waiting times for organs on the eas...