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Abstract: SA-PO798

Prevalence and Predictors of Suboptimal Kidney Donor Profile Index (KDPI) and Estimated Post-Transplant Survival (EPTS) Mismatches in Kidney Transplant Recipients

Session Information

Category: Transplantation

  • 2002 Transplantation: Clinical

Authors

  • Chen, Sarah, University of California San Francisco, San Francisco, California, United States
  • Grimes, Barbara A., University of California San Francisco, San Francisco, California, United States
  • Mcculloch, Charles E., University of California San Francisco, San Francisco, California, United States
  • Vincenti, Flavio, University of California San Francisco, San Francisco, California, United States
  • Ku, Elaine, University of California San Francisco, San Francisco, California, United States
Background

Under the current Kidney Allocation System, longevity matching of transplant candidates with deceased donor organs occurs through matching of the Kidney Donor Profile Index (KDPI) to the Estimated Post-Transplant Survival (EPTS). Our objective was to explore predictors and outcomes of population with large mismatches in KDPI and EPTS (defined in Figure).

Methods

Adults who received deceased donor transplantation between 2015-2019 according to the USRDS were included. Logistic regression models were used to identify predictors of a high KDPI/low EPTS or low KDPI/high EPTS match (Figure) in separate models. Candidate predictors included demographic, comorbidity, and laboratory data. To confirm if these mismatches had differential graft outcomes, we examined the risk of graft loss in each of these groups compared to those with closer categories of matching between KDPI and EPTS.

Results

Table 1 shows predictors of the two mismatch types. Results were similar when highly sensitized (calculated panel reactive antibody>80%) or repeat transplant recipients were excluded. In Cox models, we found the expected outcomes: higher risk of graft loss for high KDPI/low EPTS mismatched population (HR 1.62; 95% CI 1.36–1.94) and lower risk of graft loss for low KDPI/high EPTS mismatched population (HR 0.46; 95% CI 0.37–0.58).

Conclusion

Extreme matches in KDPI/EPTS are present in >20% of transplant recipients. Some variables, such as donor and recipient race, are consistently predictive of low-quality organs being matched to recipients with high EPTS or vice versa. Further studies are needed to understand the reasons for these mismatches given that such mismatches do associate with different risks of long-term graft outcomes.