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Early Transplant Outcomes and Kidney Donor Profile Index Risk Prediction Performance in Kidneys Recovered Using a Uniform Abdominal Normothermic Regional Perfusion Technique

Year: 2026

Type: article

Abstract: BACKGROUND: Abdominal normothermic regional perfusion (aNRP) may mitigate ischemic injury in donation after circulatory death (DCD). Specific aNRP-DCD kidney transplant (KTx) outcomes are inadequately defined. Kidney Donor Profile Index (KDPI) assigns equivalent DCD risk components to all DCD kidneys and may not capture procurement-related differences. METHODS: We retrospectively analyzed KTx from donors in a single donation service area procured between January 2023-December 2024. DCD-restricted multivariable logistic and Cox models compared aNRP-DCD with super-rapid recovery (SRR)-DCD and evaluated KDPI associations with delayed graft function (DGF) and 1-year overall graft survival. RESULTS: 523 KTx (310 from brain-dead donors (BDD), 122 from SRR-DCD, 91 from aNRP-DCD). aNRP-DCD kidneys came from older, higher-KDPI donors than SRR-DCD and BDD (Age 55 vs 43.5 vs 38 years; p = 0.01, p < 0.001; KDPI 66% vs 53% vs 27%; p = 0.008, p < 0.001). In DCD-restricted multivariable analysis, aNRP was associated with lower DGF odds than SRR (OR 0.445, 95% CI 0.23-0.861; p = 0.016). KDPI was associated with DGF (OR 1.028, 95% CI 1.014-1.042; p < 0.001). One-year overall graft survival was similar. KDPI interaction modeling suggested lower DGF odds at comparable KDPI values, however the KDPI × donor-type interaction was not statistically significant. CONCLUSIONS: In this uniform cohort, aNRP had lower DGF odds than SRR despite higher risk. KDPI-DGF interaction patterns were concordant in SRR-DCD kidneys but less clear in aNRP-DCD; however, formal interaction was not significant. These findings suggest that aNRP-DCD may modify early graft risk; however, larger studies with longer follow-up are needed to determine whether aNRP-DCD affects longer-term outcomes or KDPI performance.

Source: Clinical Transplantation

DOI: 10.1111/ctr.70729