Temporal Trends in the Quality of Deceased Donor Kidneys and Kidney Transplant Outcomes in Europe: an analysis by the ERA-EDTA Registry

Maria Pippias; Vianda S. Stel; Miha Arnol; Frederike Bemelman; Stefan P. Berger; Jadranka Buturovic Buturovic Ponikvar; Reinhard Kramar; Ángela Magaz; Maurizio Nordio; Hessel Peters-Sengers; Anna Varberg Reisæter; Søren S. Sørensen; Ziad A. Massy; Kitty J. Jager

doi:10.1093/ndt/gfab156

Temporal Trends in the Quality of Deceased Donor Kidneys and Kidney Transplant Outcomes in Europe: an analysis by the ERA-EDTA Registry

Maria Pippias^*, Vianda S. Stel, Miha Arnol, Frederike Bemelman, Stefan P. Berger, Jadranka Buturovic Buturovic Ponikvar, Reinhard Kramar, Ángela Magaz, Maurizio Nordio, Hessel Peters-Sengers, Anna Varberg Reisæter, Søren S. Sørensen, Ziad A. Massy, Kitty J. Jager

^*Corresponding author for this work

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Abstract

BACKGROUND: We investigated ten-year trends in deceased donor kidney quality expressed as the kidney donor risk index (KDRI) and subsequent effects on survival outcomes in a European transplant population.

METHODS: Time trends in the crude and standardised KDRI between 2005-2015, by recipient age, sex, diabetic status, and country were examined in 24,177 adult kidney transplant recipients in seven European countries. We determined five-year patient and graft survival probabilities and the risk of death and graft loss by transplant cohort (cohort 1: 2005-2006, cohort 2: 2007-2008, cohort 3: 2009-2010) and KDRI quintile.

RESULTS: The median crude KDRI increased by 1.3% annually from 1.31 (interquartile range, IQR: 1.08-1.63) in 2005 to 1.47 (IQR: 1.16-1.90) in 2015. This increase i.e., lower kidney quality, was driven predominantly by increases in donor age, hypertension and donation after circulatory death. With time, the gap between the median standardised KDRI in the youngest (18-44 years) and eldest (>65 years) recipients widened. There was no difference in the median standardised KDRI by recipient sex. The median standardised KDRI was highest in Austria, the Netherlands, and Basque Country (Spain). Within each transplant cohort, the 5-year patient and graft survival probability were higher for the lowest KDRIs. There was no difference in the patient and graft survival outcomes across transplant cohorts, however over time the survival probabilities for the highest KDRIs improved.

CONCLUSIONS: The overall quality of deceased donor kidneys transplanted between 2005-2015 has decreased and varies between age groups and countries. Overall patient and graft outcomes remain unchanged.

Original language	English
Article number	gfab156
Pages (from-to)	175-186
Number of pages	12
Journal	Nephrology Dialysis Transplantation
Volume	37
Issue number	1
Early online date	12 Apr 2021
DOIs	https://doi.org/10.1093/ndt/gfab156
Publication status	Published - 1 Jan 2022

Bibliographical note

Publisher Copyright:
© 2021 The Author(s) 2021. Published by Oxford University Press on behalf of ERA-EDTA.

Keywords

deceased donors
epidemiology
Survival Outcomes
transplantation

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Pippias, M., Stel, V. S., Arnol, M., Bemelman, F., Berger, S. P., Buturovic Ponikvar, J. B., Kramar, R., Magaz, Á., Nordio, M., Peters-Sengers, H., Reisæter, A. V., Sørensen, S. S., Massy, Z. A., & Jager, K. J. (2022). Temporal Trends in the Quality of Deceased Donor Kidneys and Kidney Transplant Outcomes in Europe: an analysis by the ERA-EDTA Registry. Nephrology Dialysis Transplantation, 37(1), 175-186. Article gfab156. https://doi.org/10.1093/ndt/gfab156

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title = "Temporal Trends in the Quality of Deceased Donor Kidneys and Kidney Transplant Outcomes in Europe: an analysis by the ERA-EDTA Registry",

abstract = "BACKGROUND: We investigated ten-year trends in deceased donor kidney quality expressed as the kidney donor risk index (KDRI) and subsequent effects on survival outcomes in a European transplant population.METHODS: Time trends in the crude and standardised KDRI between 2005-2015, by recipient age, sex, diabetic status, and country were examined in 24,177 adult kidney transplant recipients in seven European countries. We determined five-year patient and graft survival probabilities and the risk of death and graft loss by transplant cohort (cohort 1: 2005-2006, cohort 2: 2007-2008, cohort 3: 2009-2010) and KDRI quintile.RESULTS: The median crude KDRI increased by 1.3% annually from 1.31 (interquartile range, IQR: 1.08-1.63) in 2005 to 1.47 (IQR: 1.16-1.90) in 2015. This increase i.e., lower kidney quality, was driven predominantly by increases in donor age, hypertension and donation after circulatory death. With time, the gap between the median standardised KDRI in the youngest (18-44 years) and eldest (>65 years) recipients widened. There was no difference in the median standardised KDRI by recipient sex. The median standardised KDRI was highest in Austria, the Netherlands, and Basque Country (Spain). Within each transplant cohort, the 5-year patient and graft survival probability were higher for the lowest KDRIs. There was no difference in the patient and graft survival outcomes across transplant cohorts, however over time the survival probabilities for the highest KDRIs improved.CONCLUSIONS: The overall quality of deceased donor kidneys transplanted between 2005-2015 has decreased and varies between age groups and countries. Overall patient and graft outcomes remain unchanged.",

keywords = "deceased donors, epidemiology, Survival Outcomes, transplantation",

author = "Maria Pippias and Stel, {Vianda S.} and Miha Arnol and Frederike Bemelman and Berger, {Stefan P.} and {Buturovic Ponikvar}, {Jadranka Buturovic} and Reinhard Kramar and {\'A}ngela Magaz and Maurizio Nordio and Hessel Peters-Sengers and Reis{\ae}ter, {Anna Varberg} and S{\o}rensen, {S{\o}ren S.} and Massy, {Ziad A.} and Jager, {Kitty J.}",

note = "Publisher Copyright: {\textcopyright} 2021 The Author(s) 2021. Published by Oxford University Press on behalf of ERA-EDTA.",

year = "2022",

month = jan,

day = "1",

doi = "10.1093/ndt/gfab156",

language = "English",

volume = "37",

pages = "175--186",

journal = "Nephrology Dialysis Transplantation",

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Pippias, M, Stel, VS, Arnol, M, Bemelman, F, Berger, SP, Buturovic Ponikvar, JB, Kramar, R, Magaz, Á, Nordio, M, Peters-Sengers, H, Reisæter, AV, Sørensen, SS, Massy, ZA & Jager, KJ 2022, 'Temporal Trends in the Quality of Deceased Donor Kidneys and Kidney Transplant Outcomes in Europe: an analysis by the ERA-EDTA Registry', Nephrology Dialysis Transplantation, vol. 37, no. 1, gfab156, pp. 175-186. https://doi.org/10.1093/ndt/gfab156

TY - JOUR

T1 - Temporal Trends in the Quality of Deceased Donor Kidneys and Kidney Transplant Outcomes in Europe

T2 - an analysis by the ERA-EDTA Registry

AU - Pippias, Maria

AU - Stel, Vianda S.

AU - Arnol, Miha

AU - Bemelman, Frederike

AU - Berger, Stefan P.

AU - Buturovic Ponikvar, Jadranka Buturovic

AU - Kramar, Reinhard

AU - Magaz, Ángela

AU - Nordio, Maurizio

AU - Peters-Sengers, Hessel

AU - Reisæter, Anna Varberg

AU - Sørensen, Søren S.

AU - Massy, Ziad A.

AU - Jager, Kitty J.

PY - 2022/1/1

Y1 - 2022/1/1

N2 - BACKGROUND: We investigated ten-year trends in deceased donor kidney quality expressed as the kidney donor risk index (KDRI) and subsequent effects on survival outcomes in a European transplant population.METHODS: Time trends in the crude and standardised KDRI between 2005-2015, by recipient age, sex, diabetic status, and country were examined in 24,177 adult kidney transplant recipients in seven European countries. We determined five-year patient and graft survival probabilities and the risk of death and graft loss by transplant cohort (cohort 1: 2005-2006, cohort 2: 2007-2008, cohort 3: 2009-2010) and KDRI quintile.RESULTS: The median crude KDRI increased by 1.3% annually from 1.31 (interquartile range, IQR: 1.08-1.63) in 2005 to 1.47 (IQR: 1.16-1.90) in 2015. This increase i.e., lower kidney quality, was driven predominantly by increases in donor age, hypertension and donation after circulatory death. With time, the gap between the median standardised KDRI in the youngest (18-44 years) and eldest (>65 years) recipients widened. There was no difference in the median standardised KDRI by recipient sex. The median standardised KDRI was highest in Austria, the Netherlands, and Basque Country (Spain). Within each transplant cohort, the 5-year patient and graft survival probability were higher for the lowest KDRIs. There was no difference in the patient and graft survival outcomes across transplant cohorts, however over time the survival probabilities for the highest KDRIs improved.CONCLUSIONS: The overall quality of deceased donor kidneys transplanted between 2005-2015 has decreased and varies between age groups and countries. Overall patient and graft outcomes remain unchanged.

AB - BACKGROUND: We investigated ten-year trends in deceased donor kidney quality expressed as the kidney donor risk index (KDRI) and subsequent effects on survival outcomes in a European transplant population.METHODS: Time trends in the crude and standardised KDRI between 2005-2015, by recipient age, sex, diabetic status, and country were examined in 24,177 adult kidney transplant recipients in seven European countries. We determined five-year patient and graft survival probabilities and the risk of death and graft loss by transplant cohort (cohort 1: 2005-2006, cohort 2: 2007-2008, cohort 3: 2009-2010) and KDRI quintile.RESULTS: The median crude KDRI increased by 1.3% annually from 1.31 (interquartile range, IQR: 1.08-1.63) in 2005 to 1.47 (IQR: 1.16-1.90) in 2015. This increase i.e., lower kidney quality, was driven predominantly by increases in donor age, hypertension and donation after circulatory death. With time, the gap between the median standardised KDRI in the youngest (18-44 years) and eldest (>65 years) recipients widened. There was no difference in the median standardised KDRI by recipient sex. The median standardised KDRI was highest in Austria, the Netherlands, and Basque Country (Spain). Within each transplant cohort, the 5-year patient and graft survival probability were higher for the lowest KDRIs. There was no difference in the patient and graft survival outcomes across transplant cohorts, however over time the survival probabilities for the highest KDRIs improved.CONCLUSIONS: The overall quality of deceased donor kidneys transplanted between 2005-2015 has decreased and varies between age groups and countries. Overall patient and graft outcomes remain unchanged.

KW - deceased donors

KW - epidemiology

KW - Survival Outcomes

KW - transplantation

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U2 - 10.1093/ndt/gfab156

DO - 10.1093/ndt/gfab156

M3 - Article (Academic Journal)

C2 - 33848355

SN - 0931-0509

VL - 37

SP - 175

EP - 186

JO - Nephrology Dialysis Transplantation

JF - Nephrology Dialysis Transplantation

IS - 1

M1 - gfab156

ER -

Temporal Trends in the Quality of Deceased Donor Kidneys and Kidney Transplant Outcomes in Europe: an analysis by the ERA-EDTA Registry

Abstract

Bibliographical note

Keywords

UN SDGs

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