An Examination of the Application of the Kidney Donor Risk Index in British Columbia

BACKGROUND: The Kidney Donor Risk Index (KDRI) is a continuous measure of deceased donor kidney transplant failure risk that was derived in US patients based on 10 donor characteristics. In the United States, the KDRI is utilized to guide organ allocation and to inform clinical decisions regarding organ acceptance. OBJECTIVE: To examine the application of the US-derived KDRI in a large Canadian province. PATIENTS: All deceased donor kidney-only transplant recipients in British Columbia (BC) between 2005 and 2014. METHODS: We examined the predictive performance of KDRI in BC transplant recipients and compared the overall performance of KDRI with donor age alone in predicting transplant failure (from all causes including death). RESULTS: Donors in BC (N = 785) were older but included no black donors and few Hepatitis C virus (HCV)-positive donors compared with the original derivation cohort of the KDRI in the United States. The KDRI was moderately predictive of transplant failure (c statistic, 0.63) and had similar predictive performance to donor age alone (c statistic, 0.64). CONCLUSION: Our findings suggest that the US-derived KDRI does not improve the prediction of kidney transplant failure compared with donor age alone in a Canadian cohort and highlight the need to determine the applicability of KDRI in different regions.