Yonsei Med J.  2010 Nov;51(6):870-876. 10.3349/ymj.2010.51.6.870.

Assessment of Deceased Donor Kidneys Using a Donor Scoring System

• Bang K
• Lee HK
• Huh W
• Lee YJ
• Woon BS
• Ro H
• Hwang YH
• Ha J
• Park MH
• Kim SJ
• Park SK
• Oh HY
• Yang J
• Ahn C

• KMID: 1779633
• DOI: http://doi.org/10.3349/ymj.2010.51.6.870

Abstract

PURPOSE
Marginal grafts should be used more actively in Asian countries where deceased donor transplantation is unpopular. We modified a quantitative donor scoring system proposed by Nyberg and his colleagues and developed a donor scoring system in order to assess the quality of deceased donor grafts and their prognostic value as an initial effort to promote usage of marginal donors.
MATERIALS AND METHODS
We retrospectively evaluated 337 patients.
RESULTS
A scoring system was derived from six donor variables [age, 0-25; renal function, 0-4; history of hypertension, 0-4; Human Leukocyte Antigen (HLA) mismatch, 0-3; body weight, 0-1; cause of death, 0-3 points]. Donor grafts were stratified by scores: grade A, 0-10; grade B, 11-20; grade C, 21-30; and grade D, 31-40 points. Donor grades significantly correlated with estimated glomerular filtration rate (eGFR) at 6 months (A, 64.0 mL/min/1.73 m2; B, 57.0 mL/min/1.73 m2; C, 46.8 mL/min/1.73 m2; p < 0.001). The five-year graft survival rate was also lower in grade C than grade A (74% vs. 93%, p = 0.002). Donors in grade C and D were regarded as marginal donors. The proportion of marginal donors was much lower in Korea, compared with data from the United Network for Organ Sharing (15.2% vs. 29%).
CONCLUSION
Considering the scarcity of deceased donor kidneys and the relatively better graft outcome with lower grade-donors in Korea, it is worth increasing the usage of marginal grafts.

Keyword

Kidney transplantation; cadaver; donor selection

MeSH Terms

Adolescent
Adult
Cadaver
Death
Female
Glomerular Filtration Rate
Graft Survival
Humans
Kidney/*physiology
Kidney Transplantation/*methods
Male
Middle Aged
Republic of Korea
Retrospective Studies
*Tissue Donors

Figure

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  Fig. 1 Impacts of donor age (A), history of donor hypertension (B), donor renal function (C), number of (HLA) mismatch (D), cerebrovascular cause of death (E), and donor body weight (F) on the estimated glomerular filtration rate (eGFR) of recipients 6 months after deceased kidney transplantation. HLA, human leukocyte antigen; CVA, cerebrovascular accident.

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  Fig. 2 Impacts of the deceased donor grade on the graft survival. The grade of donor kidneys had a consistent influence on graft survival after transplantation. The 5-year graft survival of grades A, B, and C kidneys were, 93%, 85%, and 74%, respectively. The difference of 5-year graft survival rates was statistically significant between grade A and grade C (p = 0.002).

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