#650 Predictive value of LKDPI on recipient's renal function one year after kidney transplantation: single-centre experience
Authors: Smyrli Maria , Oikonomaki Theodora , Darema Maria , Vallianou Kalliopi , Boletis Ioannis , Marinaki Smaragdi 
Published: May 2024

Abstract

Background and Aims
The selection of the appropriate living kidney donor can be challenging, given the absence of a definitive method to determine the quality of the renal graft. This decision requires a delicate balance, weighing the recipient's benefits while prioritizing the safety of the donor. Recently, a tool known as the Living Kidney Donor Profile Index (LKDPI) was proposed to assess living donor kidneys, based on various donor characteristics, so as to predict the probability of recipient's graft loss; however, the validation of its effectiveness still needs to be proven.

Method
We evaluated retrospectively 147 stable living kidney donors, who donated between 01/2021 and 11/2023 and are currently attending the Living Donor Clinic of our Department. Our study aimed to assess the impact of the LKDPI on the recipient's estimated renal glomerular filtration rate (eGFR) (measured by the CKD-EPI) one-year posttransplant. Additionally, dialysis vintage, cause of CKD, comorbidities and medication were also determined in all recipients.

Results
The study comprised 147 stable kidney recipients (KTR), each with their respective living donor. Of these, 96 (65.3%) were males, with a mean age 44.02 ± 13.96 years and a mean dialysis vintage of 1.8 ± 2.3 years. In parallel, living kidney donors were predominantly females (70.7%), with a mean age of 59.08 ± 10.36 years and a mean eGFR prior to donation of 95 ± 13.11 ml/min/1.73 m². Furthermore, 20.1% of kidney transplantations were ABO incompatible and the mean LKDPI score was 34.6 ± 25.9%. Data analysis revealed a statistically significant negative correlation between LKDPI and the recipient's GFR one year after transplantation (p &lt; 0.0001), suggesting that higher LKDPI scores were associated with lower renal function in recipients. In a post hoc analysis, KTRs who were on CKD stage 1, one-year post-transplantation, demonstrated no statistical difference in LKDPI values, compared to stage 2 (p = 0.35). Meanwhile recipients on stage 3 exhibited comparable LKDPI values to those on stage 4 (p = 0.821). The main statistical discrepancy was particularly evident between CKD stage 2 and 3, as recipients with a LKDPI surpassing 25.6, experienced a transition from stage 2 to stage 3 within the first year following transplantation (p &lt; 0.0001). In addition, after multivariate analysis there were no correlations between KTR's eGFR and age difference between donor and recipient or recipient's smoking history or medication. Last, dialysis vintage or the number of previous transplantations did not affect recipient's kidney function.

Conclusion
LKDPI seems to be a promising tool for predicting the outcome of kidney transplantation, concerning the renal function of KTR particularly at the end of the first-year post-transplant However, it needs to be thoroughly evaluated before being considered as a decision-making factor in living kidney transplantations.