Validation of Kidney Donor Profile Index and Estimated Post-Transplant Survival Scores in an Eastern European Transplantation Center—A Seven-Year Retrospective Observational Study

<b>Background/Objectives:</b> The Kidney Donor Profile Index (KDPI) is an important metric for evaluating the quality of donor kidneys and predicting post-transplant outcomes. The Estimated Post-Transplant Survival (EPTS) score is a tool for estimating kidney transplant candidates' long-term survival. However, their validity in Eastern European cohorts is yet to be explored. This study aimed to evaluate the predictive accuracy of the KDPI and EPTS in a local cohort. <b>Methods:</b> We conducted a seven-year retrospective observational study at a high-volume transplant center in Romania. Data from 353 patients who received kidney transplants from brain-dead donors (DBDs) between 2017 and 2023 were analyzed. The KDPI scores were stratified into <35%, 35-85%, and >85%, while EPTS was stratified into <20%, 20-60%, and >60%. Primary outcomes included one-, three-, and five-year post-transplant graft function as estimated by eGFR, while secondary outcomes involved patient and graft survival rates at one, three, and five years. <b>Results:</b> Graft function and survival rates were significantly lower with increasing KDPI and EPTS scores, reinforcing the utility of both scores in clinical decision-making. <b>Conclusions:</b> Despite their limitations, KDPI and EPTS remain valuable predictors in our patient population.