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Kidney Week

Abstract: PO2412

Outcomes of High Kidney Donor Profile Index Kidneys at a Large Center

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Pagan, Javier, Miami Transplant Institute, Miami, Florida, United States
  • Preczewski, Luke, Miami Transplant Institute, Miami, Florida, United States
  • Muldoon, Meghan, Miami Transplant Institute, Miami, Florida, United States
  • Mendez Castaner, Lumen Alberto, Miami Transplant Institute, Miami, Florida, United States
  • Harshman, Amy L., Miami Transplant Institute, Miami, Florida, United States
  • Shipman, Elizabeth, Miami Transplant Institute, Miami, Florida, United States
  • Goggins, Mariella Ortigosa, Miami Transplant Institute, Miami, Florida, United States
  • Guerra, Giselle, Miami Transplant Institute, Miami, Florida, United States
Background

Kidneys from donors with high Kidney Donor Profile Index (KDPI) are often discarded due to concerns about outcomes. Despite decreased survival, the survival benefit of receiving a transplant and avoiding time on dialysis is beneficial, especially for selected patients.

Methods

We increased use of high KDPI (KDPI>85) deceased donor kidneys (DDKT) over several years. We performed a single-center analysis of 1119 consecutive adult DDKT from 2016-2019. Our endpoints were Kaplan-Meier death-censored graft survival (HR calculated by the Cox Proportional Hazards model) and eGFR by MDRD equation at 3, 6, and 12 months post-transplant. Mean eGFR was compared for significance using a t-test.

Results

1119 patients were transplanted: 205 (18.3%) received a kidney from a donor with KDPI > 85% vs. 914 (81.7%) from a donor with a KDPI of <=85%. As expected, the high KDPI group had a higher mean age (66.5 vs. 53.6 (p < 0.0001) and a higher mean EPTS (74.7 vs. 50.4 (p<0.0001), reflecting deliberate selection.
Death-censored graft survival at 1yr was 91.9% (CI: 86.9-95.0) in the high KDPI group vs 96.7% (CI: 95.3-97.7) in other recipients. High KDPI was a significant risk factor for death-censored graft survival (HR: 1.91; p=0.017).
1-yr mean eGFR by MDRD equation in patients alive with followup was 49.0 ml/min/1.73m2 in the high KDPI group vs 62.3 ml/min/1.73m2 in the < 85% KDPI group (p<0.0001). Box-and-whiskers plots of 3, 6, and 12-year eGFR are shown (figure 1).

Conclusion

Despite reduced graft survival, high KDPI kidneys offered renal function to 91.9% of surviving patients at 1 year. eGFR was also consistently lower, but provided good function to those recipients. Utilizing high KDPI kidneys in well-selected recipients is an important aspect of reducing waiting time and morbidity and mortality of dialysis.

Figure 1. eGFR by MDRD at 3, 6, and 12 months for recipients of KDPI <= 85 (0) vs. KDPI > 85 (1)

Funding

  • Clinical Revenue Support