Introduction: The Kidney Donor Profile Index (KDPI) (a scoring system based on 10 donor factors) is usually used in USA as a screening tool for donor quality and has been shown to be predictive of both short and long term graft survival. However, whether this clinical tool has accuracy predictive value in other population is undetermined.
Objective: To evaluate the association between KDPI and graft survival in Southern European deceased donor kidney transplant recipients (DKT).
Methods: A longitudinal, retrospective cohort study, where were included 733 DKT performed in our center (Regional University Hospital, Málaga, Spain) during 1999-2012. KDPI was calculated in all deceased donors.
Results: Recipient´s mean age was 49,9±13,8 ys. and 61,1% were male. Mean dialysis time was 38±35 months. 85% was the first transplant. Donor´s mean age was 49,4±17,3 years, and hypertension and diabetes was present in 31,7% and 12%, respectively. Stroke was the cause of donor death in 61%. There was no deceased after cardiac-death. Cold ischemia time (CIT) was 15,3±4,5 h. and 41% of patients had delayed graft function. The most commonly used immunosuppressive treatment was steroids, MMF and Tacrolimus (88%). Induction therapy (46,4% antiCD25, 14,4% thymoglobuline) was administered in 61% of patients. A total of 150 patients (17.1%) lost the graft during follow-up (96±58 months) and the leading cause of loss was death with functioning graft.

Median KDPI was 63 (IQR 34-86). Patients were divided into 2 categories: KDPI ≤80 (502 patients) and KDPI>80 (231 patients). Donors with KDPI>80 were older (65±7 vs 41±14 years; p<0.001), and had more hypertension (63% vs 16%; p<0.001) and diabetes (26,3% vs 5,4%; p<0.001). The patients who received a kidney with KDPI >80 also were older (60±8 vs 45±13 years; p<0.001) and had a higher proportion of diabetics (14,4% vs 6,9%; p=0.001). There were no differences in CIT (15,6±4,2 vs 15,2±4,6; p=0.3). Overall graft survival at first, 5th  and 10th  years was significantly lower in patients with KDPI>80 vs ≤80, ( 88%, 74%, 52% vs 91%, 83%, 70%, respectively; p<0.001), as well as patient death-censored graft survival (91%, 83%, 71% vs 93%, 87%,80%; respectively, p=0.03; Figure). This difference was not significant in the recipients over 60 years . In multivariate cox regression analysis, a KDPI value (≤ o > 80) was significantly associated with graft failure (HR 1.9; 95% IC 1.1-3.3; p=0.009).
Conclusions: A KDPI value >80 represents an important risk factor for graft loss in our kidney transplant population, with an increased of risk of 1.7 times. These differences are not significant in patients older than 60 years, so these grafts could be viable for this specific population.