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Kidney Week

Abstract: PO2425

Composite Events Associated with Increased Expected Post-Transplant Survival Scores

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Dhindsa, Yasmeen, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, United States
  • Datta, Nakul N., University of California Los Angeles, Los Angeles, California, United States
  • Homkrailas, Piyavadee, University of California Los Angeles, Los Angeles, California, United States
  • Bunnapradist, Suphamai, University of California Los Angeles, Los Angeles, California, United States
  • Lum, Erik Lawrence, University of California Los Angeles, Los Angeles, California, United States
Background

Kidney transplant candidates on the waiting list are assigned an expected post transplant survival (EPTS) score. This score is used to determine allocation of kidneys in the kidney allocation system (KAS). The outcomes of candidates with an EPTS >95% at the time of listing is limited.

Methods

UCLA kidney Transplant Program data of waiting list with EPTS > 80% from January 2015 – December 2018 were included. Median follow up time of waiting list was 845 days. The outcomes included kidney transplant rate, 3 year death censored graft survival and patient survival in candidates with EPTS ≥ 95% compared with EPTS < 95%.

Results

A total of 124 patients were identified with an EPTS score > 95% at the time of listing during the study period. Of these patients 23 received a kidney transplant during the specified time frame (transplant rate of 16.9%). Recipients of kidney transplant had a longer dialysis vintage (2368.6 days vs. 9881 days, P< 0.0001) and were more sensitized at the time of listing (34.8% vs. 11.8%, p=0.018). Compared to a group with an EPTS between 80-94% at time of listing (n=170) there were no differences in mortality (4.35% vs. 4.55%, p=0.969), graft failure (14.3% vs. 6.4%, p=0.254), or 3 year death censored graft survival (70.0% vs. 84.5%, p=0.517). The EPTS > 95% group was older, had a longer dialysis vintage, had a higher proportion of candidates with diabetes as a cause of ESRD, and was less likely to undergo transplantation. Candidates with an EPTS >95% who did not receive a transplant had a mortality rate of 7.9% and waitlist removal rate 16.9%.

Conclusion

Kidney transplantation in candidates with an EPTS > 95% provides comparable outcomes to candidates with an EPTS between 80-94%, which was superior to remaining on dialysis. Despite this benefit, the transplantation rate of this group was low and a quarter of those not transplanted either died or are removed from the waitlist. Strategies are needed to improve transplantation rates in this population.