Kidney Week

Abstract: TH-OR131

Decreasing Risks of Kidney Transplantation Using High KDPI Kidneys by Preferred Recipient Matching

Session Information

• Policy and Pretransplant Considerations
  November 07, 2019 | Location: 151, Walter E. Washington Convention Center
  Abstract Time: 05:06 PM - 05:18 PM

Category: Transplantation

• 1902 Transplantation: Clinical

Authors

• Jackson, Kyle R., Johns Hopkins Hospital, Baltimore, Maryland, United States

Kyle R. Jackson, MD



Kyle R. Jackson, M.D., is a General Surgery Resident at Johns Hopkins Hospital, and is completing a PhD in Clinical Investigation at the Johns Hopkins Bloomberg School of Public Health. His research focuses on utilization of marginal organs for transplantation, allocation for and outcomes of highly sensitized kidney transplant recipients, and post-transplant complications. After completing residency, he will pursue a fellowship in abdominal organ transplantation.

• Motter, Jennifer D., Johns Hopkins Hospital, Baltimore, Maryland, United States

Jennifer D. Motter,

• Segev, Dorry L., Johns Hopkins Hospital, Baltimore, Maryland, United States

Dorry L. Segev,

Group or Team Name

• Epidemiology Research Group in Organ Transplantation

Background

Kidneys with a high Kidney Donor Profile Index (KDPI, ≥ 85%) are often discarded due to an increased risk of mortality and graft loss. However, we hypothesized that some recipients might tolerate high KPDI kidneys well, and are therefore best suited to receive these grafts.

Methods

Using national registry data from SRTR from 2006-2017, we compared 10,361 kidney transplant recipients of high KDPI (≥ 85%) kidneys to 120,983 recipients of low KDPI (< 85%) kidneys. We identified recipient factors that amplified (or attenuated) the impact of high KDPI on mortality and graft loss using interaction analysis, classifying recipients without amplifying factors and with attenuating factors as preferred recipients. We compared mortality and graft loss with high KDPI versus low KDPI kidneys in preferred and non-preferred recipients using Cox regression.

Results

Preferred recipients were determined to be recipients who were ≥ 60 years old, non-white, with diabetes, and without glomerular or cystic disease as the cause of their ESRD. The increased mortality risk associated with high KDPI kidneys was 32% lower (interaction ratio: _0.620.68_0.74, p<0.001) in preferred vs. non-preferred recipients, whereas the increased risk of graft loss was 21% lower (interaction ratio: _0.730.79_0.85, p<0.001). This translated to a 1.37-fold higher mortality risk (HR: _1.261.37_1.47, p<0.001) with a high KDPI kidney versus a low KDPI kidney in preferred recipients, compared to a 2.01-fold higher mortality risk (HR: _1.902.01_2.13, p<0.001) for non-preferred recipients (Figure). Similarly, there was a 1.57-fold higher risk of graft loss (HR: _1.451.57_1.69, p<0.001) with a high KDPI kidney versus a low KDPI kidney in preferred recipients, in comparison to a 1.96-fold higher risk of graft loss (HR: _1.881.96_2.04, p<0.001) for non-preferred recipients (Figure).

Conclusion

The risks of kidney transplantation with high KDPI kidneys can be decreased by appropriate recipient selection.

Funding

• NIDDK Support