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Kidney Week

Abstract: PO2530

A Call to Action: Finding the Right Kidney for All Potential Recipients

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Guerra, Giselle, Miami Transplant Institute, Miami, Florida, United States
  • Preczewski, Luke, Miami Transplant Institute, Miami, Florida, United States
  • Mendez Castaner, Lumen Alberto, Miami Transplant Institute, Miami, Florida, United States
  • Pagan, Javier, Miami Transplant Institute, Miami, Florida, United States
  • Harshman, Amy L., Miami Transplant Institute, Miami, Florida, United States
  • Figueiro, Jose M., Miami Transplant Institute, Miami, Florida, United States
  • Ciancio, Gaetano, Miami Transplant Institute, Miami, Florida, United States
  • Vianna, Rodrigo, Miami Transplant Institute, Miami, Florida, United States
Background

The burden of dialysis among ESRD patients is a huge driver of morbidity, mortality, and cost. Thousands of deceased-donor (DD) kidneys that almost certainly have better outcomes than dialysis are discarded each year. Our center sought to find and transplant kidneys that would reduce waiting time for our patients while preserving post-transplant outcomes consistent with nationally expected results.

Methods

We reviewed 1119 consecutive DDKT recipients transplanted between 1/1/2016 and 12/31/2019 at our center. Endpoints were eGFR by MDRD death-censored graft survival using Kaplan-Meier survival estimation and the Cox Proportional Hazards Model. We reviewed on additional year (2015) for waiting time impact.

Results

DD KT volumes doubled from 2016 to 2019 (191 vs. 384). Growth was attributable to increased acceptance of hard-to-place imported kidneys, including kidneys with AKI (413% increase) and KDPI > 85 (296% increase). In 2016, 46.6% of DD kidneys were imported from outside our DSA and by 2019, 77.3% were imported.
Overall one-year patient survival was 96.6% (CI: 95.4-97.6%) and death-censored one-year graft survival was 95.8% (CI: 94.4%-97.6%). Recipients with any stage of AKI saw no additional risk vs. donors without AKI (HR 0.94, p=0.854) while death-censored graft survival at one year was 91.9% for recipients of kidneys with KDPI >85% vs 96.7% with KDPI <85%, representing significant additional risk (HR: 1.91; p=0.017).
This significantly decreased waiting time at transplant across all blood types (6.4 years in 2015 to 3.9 years in 2019). This benefit was even greater for blood group B (10.7 to 4.3), and significantly reduced the disparity in accrued waiting times for African-American and Hispanic populations.
Kidney function was good at 1 year in all groups among those surviving with followup. Mean eGFR by MDRD formula was 60.0 (SD 23.2) in recipients with non-AKI donors and 61.9 (SD 26.1) in recipients with AKI donors (p=0.4384). Mean eGFR 49.0 in the KDPI > 85% group vs 62.3 in the <= 85% KDPI group (p<0.0001).

Conclusion

Transplant centers can answer the growing demands of patients enduring dialysis to better utilize kidneys that have previously been discarded. Our center has demonstrated that it is possible to reduce waiting time, and maintain outcomes using kidneys previously discarded.

Funding

  • Clinical Revenue Support