Introduction to Kidney Donor Risk Index (DRI) Data Update Introduction to Kidney Donor Risk Index (DRI)

Donor Risk Index (DRI) ECD/SCD definition of donor quality is insufficient as many so called “ECD” kidneys are of equal or better quality than some “SCD” kidneys The SRTR has developed continuous measures that better quantify the risk associated with certain organs and has published these for liver and kidney1,2. The OPTN/UNOS Kidney Transplantation Committee has been considering ways to introduce the concept of a Donor Risk Index into a new allocation system 1Feng et al., Characteristics associated with liver graft failure: the concept of a donor risk index. Am J Transplant. 2006;6:783-790 2Rao et al., A comprehensive risk quantification score for deceased donor kidneys: the kidney donor risk index. Transplantation 2009;88:231-236

Objectives of this Presentation To illustrate some basic donor recovery information stratified by the DRI rather than just the ECD/SCD/DCD criteria. To familiarize you with the concept of the DRI and help you to understand how various donor characteristics relate to DRI. To examine some of the variability in donors recovered by DRI across regions and DSAs.

This slide illustrates the overlap in the SCD and ECD donor population in terms of relative risk of failure. The grey bars show the % of transplants done that were classified as SCD, and the white bars illustrate the ECD transplants. This slide shows that there is not a single “cut-point” where an SCD donor ends and an ECD donor begins.

Factors included in Kidney DRI Calculation1 Donor Age Ethnicity Serum Creatinine Hypertension Diabetes Cause of death Height Weight DCD HCV+ Transplant * HLA Mismatch Level Cold ischemia time Transplant type (enbloc/double/single) 1Rao et al., A comprehensive risk quantification score for deceased donor kidneys: the kidney donor risk index. Transplantation 2009;88:231-236 * Transplant factors were set to “baseline” for this presentation

Deceased Donors by Type 1998 – 2008 U.S. For years, we’ve shown you slides like this – donors recovered in 3 categories.

Kidney Donor Risk Index Deceased Donors Recovered 1998 - 2008 This slide illustrates the same information, using 5 categories of donor risk.

Kidney Donor Risk Index Deceased Donors Recovered 1998 - 2008 When you look at the percentage of donors recovered in each of the categories, you can see that the biggest increases are seen in the white and green sections of the bars – illustrating the highest risk categories

All Deceased Donors Recovered 2008 Kidney DRI Distribution

The following slides show the distribution of the Kidney Donor Risk Index for various donor characteristics

How to interpret the boxplots… 95th Percentile 75th Percentile Median (middle of box) You may or may not want to include this slide. Shows you how to describe the following slides. 25th Percentile 5th Percentile

All Deceased Donors Recovered 2008 Kidney DRI By Donor Age

All Deceased Donors Recovered 2008 Kidney DRI By Donor Age

All Deceased Donors Recovered 2008 Kidney DRI By Donor Ethnicity

All Deceased Donors Recovered 2008 Kidney DRI By Donor Cause of Death

All Deceased Donors Recovered 2008 Kidney DRI By Donor Gender

All Deceased Donors Recovered 2008 Kidney DRI By Donor BMI

All Deceased Donors Recovered 2008 Kidney DRI By Donor BMI

All Deceased Donors Recovered 2008 – Kidney DRI By Donor Type (SCD/DCD/ECD/ECD&DCD)

All Deceased Donors Recovered Kidney DRI 1998 vs. 2008

All Deceased Donors Recovered Kidney DRI 1998 vs. 2008

All Deceased Donors Recovered 2008 Kidney DRI by Region

All Deceased Donors Recovered 2008 Kidney DRI Quintile by Region of Recovery

Donors Recovered vs. Median DRI Lower Volume Higher Risk Higher Volume Higher Risk This slide is just for illustration purposes – use it to explain the next slide. Wide variability in the volume of donors recovered – and variability in DRI across DSAs. Lower Volume Lower Risk Higher Volume Lower Risk

All Deceased Donors Recovered 2008 Donors Recovered vs. Median Kidney DRI Each dot represents a DSA. The axes cross at the median DRI for donors (1.27) and at the median # of donors recovered across DSAs (~125) in 2008. This raises a number of questions – should there be uniformity across DSAs? Are those with a median DRI much higher than US median pushing the envelope too far? Or, are those with DRI< national median not pushing hard enough? We don’t know the answer to that question, but it is interesting to consider.

All Deceased Donors Recovered 2008 Region 1

All Deceased Donors Recovered 2008 Region 2

All Deceased Donors Recovered 2008 Region 3

All Deceased Donors Recovered 2008 Region 4

All Deceased Donors Recovered 2008 Region 5

All Deceased Donors Recovered 2008 Region 6

All Deceased Donors Recovered 2008 Region 7

All Deceased Donors Recovered 2008 Region 8

All Deceased Donors Recovered 2008 Region 9

All Deceased Donors Recovered 2008 Region 10

All Deceased Donors Recovered 2008 Region 11