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Abstract: SA-PO799

Should "Marginal Kidneys" Be Offered for Repeat Transplantation? A Mate-Kidney Analysis

Session Information

Category: Transplantation

  • 2002 Transplantation: Clinical

Authors

  • Sureshkumar, Kalathil K., Allegheny Health Network, Pittsburgh, Pennsylvania, United States
  • Josephson, Michelle A., University of Chicago Pritzker School of Medicine, Chicago, Illinois, United States
  • Chopra, Bhavna, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
  • McGill, Rita L., University of Chicago Pritzker School of Medicine, Chicago, Illinois, United States
Background

Initial and subsequent kidney transplantation improves survival compared to continuing dialysis. Higher kidney donor profile index (KDPI) kidneys ("marginal kidneys") generally provide inferior transplant outcomes compared to lower KDPI kidneys. Repeat kidney transplant recipients (KTRs) are biologically more complex with increasing immunologic risk. We aimed to explore whether transplantation of high-KDPI "marginal kidneys" might result in suboptimal outcomes for repeat KTRs by utilizing a mate-kidney model.

Methods

Deceased donors in the OPTN/UNOS database from 2000 to 2019 were extracted if one kidney was transplanted into a first time recipient and the mate-kidney was transplanted into a repeat recipient. Transplant pairs were then stratified by KDPI: 0-20% (best kidneys); 21-85% (average kidneys); 86-100% ('marginal kidneys'). Using marginal models, transplant outcomes were compared between first time and repeat mate-kidney recipients.

Results

During the study period, 9502 mate-kidney pairs were identified with KDPI as follows: 0-20%= 2387; 21-85%=6800; 86-100%=315. Risks for delayed graft function (DGF), graft failure, death-censored graft failure and patient death are shown for repeat KTRs compared to first time KTRs (table).

Conclusion

Elevated risk for DGF in repeat KTRs regardless of KDPI suggests that recipient related factors are responsible. Inferior death-censored graft survival observed when higher KDPI kidneys are received by repeat KTRs suggests that these patients may preferentially benefit from lower KDPI kidneys. Transplant teams should be cautious about accepting 'marginal kidney' offers for repeat KTRs. Improved patient survival observed in repeat KTRs could possibly reflect stringent listing criteria for repeat kidney transplantation, or other factors.

Outcomes: Repeat vs. first transplant
 KDPI 0-20%KDPI 21-85%KDPI 86-100%
 OR
(95% CI)
pOR
(95% CI)
pOR
(95% CI)
p
Delayed graft function1.30
(1.10-1.54)
0.0021.15
(1.06-1.25)
0.0011.61
(1.11-2.32)
0.01
 HR
(95% CI)
pHR
(95% CI)
pHR
(95% CI)
p
Graft failure1.00
(0.89-1.12)
0.901.02
(0.96-1.09)
0.500.99
(0.89-1.120
0.90
Death-censored graft failure1.14
(0.95-1.36)
0.201.24
(1.12-1.37)
<0.0011.49
(1.06-2.09)
0.02
Patient death0.88
(0.76-1.00)
0.050.85
(0.79-0.92)
<0.0010.89
(0.69-1.14)
0.40

CI=confidence interval; HR=hazard ratio; OR-odds ratio