We investigated ten-year trends in deceased donor kidney quality expressed as the kidney donor risk index (KDRI) and subsequent effects on survival outcomes in a European transplant population.
Time trends in the crude and standardised KDRI between 2005-2015, by recipient age, sex, diabetic status, and country were examined in 24,177 adult kidney transplant recipients in seven European countries. We determined five-year patient and graft survival probabilities and the risk of death and graft loss by transplant cohort (cohort 1: 2005-2006, cohort 2: 2007-2008, cohort 3: 2009-2010) and KDRI quintile.
The median crude KDRI increased by 1.3% annually from 1.31 (interquartile range, IQR: 1.08-1.63) in 2005 to 1.47 (IQR: 1.16-1.90) in 2015. This increase i.e., lower kidney quality, was driven predominantly by increases in donor age, hypertension and donation after circulatory death. With time, the gap between the median standardised KDRI in the youngest (18-44 years) and eldest (>65 years) recipients widened. There was no difference in the median standardised KDRI by recipient sex. The median standardised KDRI was highest in Austria, the Netherlands, and Basque Country (Spain). Within each transplant cohort, the 5-year patient and graft survival probability were higher for the lowest KDRIs. There was no difference in the patient and graft survival outcomes across transplant cohorts, however over time the survival probabilities for the highest KDRIs improved.
The overall quality of deceased donor kidneys transplanted between 2005-2015 has decreased and varies between age groups and countries. Overall patient and graft outcomes remain unchanged.

© The Author(s) 2021. Published by Oxford University Press on behalf of ERA-EDTA.