Kidney donor risk index is a good prognostic tool for graft outcomes in deceased donor kidney transplantation with short, cold ischemic time

Background We performed a retrospective cohort study to determine the prognostic value of standard criteria donor/expanded criteria donor ( SCD / ECD ) designation, with regard to one‐yr GFR and graft survival rate, in a region with short, cold ischemic time ( CIT ), and how this designation compares with the kidney donor risk index ( KDRI ) and zero‐time kidney biopsies. Methods We reviewed 362 cases of deceased donor kidney transplantation ( DDKT ). Donor kidneys were classified as SCD or ECD . They were also assessed by the KDRI . Zero‐time kidney biopsy was performed in 196 patients, and histologic score was assessed. Results Median follow‐up duration was 46 months. Forty‐two cases (11.6%) used ECD kidneys. The mean CIT was only 4.9 ± 2.7 h. Graft survival rates were not significantly different between ECD and SCD groups. The KDRI showed the best correlation with one‐yr estimations of glomerular filtration rate ( eGFR ) ( R 2  = 0.230, p < 0.001), and higher KDRI was associated with a higher risk of graft failure (hazard ratio 2.63, 95% confidence interval 1.01–6.87). However, higher histologic score was not associated with a higher risk of graft failure. Conclusion KDRI has greater predictive value for short‐term outcomes in DDKT with short CIT than the SCD / ECD designation or pathology.