Kidney Donor Risk Index (KDRI) Fails to Predict Kidney Allograft Survival in HIV (+) Recipients

Introduction. We used the United Network of Organ Sharing Standard Transplant Analysis and Research Files (STAR files) to investigate the utility of the Kidney Donor Risk Index (KDRI) versus delayed graft function (DGF) to predict graft survival in the HIV (+) kidney transplant recipients. Methods. Individual matching (one case to five controls) was used to investigate predictive ability of the KDRI for graft survival in HIV (+) recipients (cases) as compared to HIV (j) recipients (controls) leaving 400 HIV (+) recipients matched with 1,904 HIV (j) recipients. Cox proportional hazard regression model was used to test association of the KDRI and DGF with graft survival. The relationship of the KDRI with graft survival was also explored by using Kaplan-Meier analysis. Results. HIV (+) and HIV (j) cohorts were well matched in terms of race, HCV co-infection, panel reactive antibody, and wait time except HIV + were more frequently diabetic. Donor qualities were similar between the cohorts, including method of allograft preservation pretransplant, HLA matching, and calculated KDRI. There was no significant difference in survival based on the KDRI quintiles among the HIV (+) cohort (logrank sum P=0.4986). Graft survival within the HIV (+) cohort was significantly worse in the DGF (+) group than the DGF (j) group (logrank P<0.01). Discussion. We found that the KDRI did not predict graft survival for HIV (+) kidney transplant recipients; however, the presence of DGF continues to have a negative impact on the graft survival. Future predictive models should include DGF as a variable.