Kidney Donor Risk Index and Cardiovascular Complications in a Long-Term Follow-Up Observation

<b>Background</b>: The suitability of the Kidney Donor Risk Index (KDRI) has not been fully validated in the European population. The aim of this study was to evaluate the value of the KDRI in predicting kidney graft function and cardiovascular events (CVEs) in a Polish cohort of kidney transplant recipients (KTRs). <b>Methods</b>: In this retrospective study kidney graft function and CVEs were analyzed among 1420 patients transplanted between 1999 and 2017 and followed until 2021. The KDRI was calculated according to the formula proposed by Rao. Patients were assigned into quartiles (Qs) of KDRI values. <b>Results</b>: Patients in Q4 were older, with higher BMI, longer cold ischemia time (CIT), and a greater rate of ischemic heart disease at the transplantation. The KDRI value determined both early and long-term graft function. During a median follow-up period of 91 months, at least one cardiovascular event was noted in 227 (16.0%) kidney transplant recipients. There was a significant increasing trend for the occurrence of post-transplant CV complications along the consecutive KDRI quartiles (χ² = 7.3; <i>p</i> < 0.01) among kidney transplant patients younger than 50 years at the time of transplantation. <b>Conclusions</b>: The KDRI is an adequate prognostic tool also for the European population. Despite the KDRI not being used for allocation in Poland we found that kidneys with a higher KDRI are allocated to recipients with worse survival prognosis. The quality of kidneys from a deceased donor may be related to the occurrence of post-transplant cardiovascular complications in recipients younger than 50 years at the transplantation, including those without history of comorbidities such as diabetes or cardiovascular disease.