Journal List > J Korean Soc Transplant > v.28(2) > 1034451

Park, Kim, Kim, and Cho: Validation of the KDRI in Korean Deceased Donor Kidney Transplantation



The United Network for Organ Sharing developed the continuous kidney donor risk index (KDRI) for measurement of the spectrum of risk associated with the various factors known to influence graft failure. This study was conducted in order to validate the KDRI in assessment of deceased donor kidney in Koreans.


Patients (n=404) who underwent kidney transplants performed at five transplantation centers from 2000 to 2010 were studied retrospectively. The distribution of the KDRI of donor kidneys was calculated and the distribution of kidney donors by standard criteria donor (SCD)/expanded criteria donor (ECD) and KDRI was compared. The KDRI were divided into five groups: <0.8, 0.8∼1.0, 1.0∼1.2, 1.2∼1.4, and ≥1.4. Graft function and graft survival among KDRI groups were analyzed.


The mean KDRI was 1.01 (range, 0.55∼1.88). More than 90% of donors had KDRI <1.4. The distribution of kidneys by KDRI groups was 22.8%, 32.7%, 27.5%, 9.9%, and 7.2%, respectively. Among kidneys with KDRI <0.8, 10.5% were ECD, whereas all of the kidneys with KDRI ≥1.4 were ECD. The estimated GFR at one-year in the KDRI groups was 72.2, 65.8, 63.2, 69.1, and 47.1 mg/dL, respectively. Graft function was significantly lower in those with KDRI ≥1.4 (P<0.001). Five-year graft survival in the KDRI groups was 91.6%, 92.2%, 91.3%, 94.1%, and 56.4%, respectively. Graft survival was also significantly lower in those with KDRI ≥1.4 (P=0.001).


The KDRI is a useful tool for estimation of posttransplant outcomes in the Korean population. The KDRI can be used by physicians as an additional assessment tool to assist in the decision making process regarding donor organ selection.


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Fig. 1.
Histogram of kidney donor risk index (KDRI). Fig. 3. Five-year graft survival by kidney donor risk index
Fig. 2.
One year estimated glomerular filtration rate (GFR) by kidney donor risk index (KDRI) category.
Fig. 3.
Five-year graft survival by kidney donor risk index (KDRI) category.
Fig. 4.
Percentages of patients in expanded criteria donor (ECD) and standard criteria donor (SCD) by kidney donor risk index category. Abbreviation: UNOS, United Network for Organ Sharing.
Table 1.
Demographics of deceased kidney donor (n=404)
Variable Value
Age 39.4±14.5
Sex, male 280 (69.3)
istory of HTN 68 (16.8)
Diabetes mellitus 10 (2.5)
Cause of death  
CVA 349 (86.4)
Others 55 (13.6)
BMI (kg/m2) 22.3±2.9
Proteinuria 11 (2.7)
Cardiotonics use  
Norepinephrine 193 (47.8)

Data are presented as mean±SD or number (%).

Abbreviations: HTN, hypertension; CVA, cerebral vascular accident; BMI, body mass index.

Table 2.
Comparisons of demographics, 1-year graft function and 5-year graft survival rate between standard criteria donor and expanded criteria donor
Variable SCD (n=322) ECD (n=53) P-value
Age 36.4±13.5 51.0±12.6 <0.001
Sex, male 224 (69.6) 56 (68.3) 0.893
History of HTN 28 (8.7) 40 (48.8) <0.001
Diabetes mellitus 4 (1.2) 6 (7.3) 0.006
Cause of death      
CVA 270 (83.9) 79 (96.3) 0.002
Others 52 (16.1) 3 (3.7)  
BMI (kg/m2) 22.1±3.0 23.0±2.5 0.007
Proteinuria 7 (2.2) 4 (4.9) 0.245
Cardiotonics use      
Norepinephrine 155 (48.1) 38 (46.3) 0.805
GFR at 1-year (mg/dL) 66.3±27.3 63.1±23.2 0.420
Graft survival rate at 95.1 93.9 0.285
5-year (%)      

Data are presented as mean±SD or number (%).

Abbreviations: SCD, standard criteria donor; ECD, expanded criteria donor; HTN, hypertension; CVA, cerebral vascular accident; BMI, body mass index; GFR, glomerular filtration rate.

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