Abstract: TH-OR60
A Mate Kidney Analysis to Determine the Impact of Preemptive Transplantation on Outcomes of High Kidney Donor Profile Index Deceased Donor Transplants
Session Information
- Kidney Transplantation: Breakthroughs from Basic to Translational to Clinical Research
November 04, 2021 | Location: Simulive, Virtual Only
Abstract Time: 04:30 PM - 06:00 PM
Category: Transplantation
- 1902 Transplantation: Clinical
Authors
- Gill, Justin, The University of British Columbia, Vancouver, British Columbia, Canada
- Kadatz, Matthew J., The University of British Columbia, Vancouver, British Columbia, Canada
- Lan, James H., The University of British Columbia, Vancouver, British Columbia, Canada
- Chang, Doris Tung, The University of British Columbia, Vancouver, British Columbia, Canada
- Gill, John S., The University of British Columbia, Vancouver, British Columbia, Canada
- Gill, Jagbir, The University of British Columbia, Vancouver, British Columbia, Canada
Background
There is an inadequate supply of kidneys for transplant. The kidney donor profile index (KDPI) combines donor factors into a percentile that summarizes the likelihood of deceased donor transplant failure. High KDPI kidneys are frequently discarded. Pre-emptive transplantation is associated with improved patient and graft survival, but it is unknown if this benefit is preserved with high KDPI kidneys.
Methods
Using the SRTR database, N = 7,232 donors were identified where one donor kidney was transplanted pre-emptively (before the recipient required dialysis) and the other was used non-pre-emptively (after the recipient has initiated dialysis). We compared all cause graft loss (ACGL), death censored graft loss (DCGL), and death with function (DWF) between the pre-emptive and non-pre-emptive recipients using univariable and multivariable time to event analyses adjusted for differences in recipient factors.
Results
Pre-emptive transplantation was associated with improved outcomes of ACGL, DCGL, and DWF (Fig 1). These results were consistent in the subgroup where the donor KDPI was >= 91%. Furthermore, the risk of ACGL with a pre-emptive transplant from a KDPI >= 91% donor (HR: 1.65, CI: 1.51 – 1.81) was similar to the risk of ACGL from a non-pre-emptive transplant from a KDPI 51-80% donor (HR: 1.57 CI: 1-48 – 1.66) (Fig 2).
Conclusion
In this mate kidney analysis, outcomes after a pre-emptive transplant were superior compared to a non-pre-emptive transplant, even among kidneys from donors with very high KDPI. Pre-emptive transplantation of high KDPI kidneys is an opportunity to safely increase the number of kidney transplants from the limited supply of deceased donor kidneys.