Abstract: TH-PO883
Use of "Marginal Kidneys" to Improve Access to Care: No Adverse Impact on Short-Term Outcomes
Session Information
- Transplantation: Donation and Access
November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2102 Transplantation: Clinical
Authors
- Cabezas, Fausto Ricardo, SUNY Downstate Health Sciences University, New York City, New York, United States
- Sasidharan, Sandeep Raja, SUNY Downstate Health Sciences University, New York City, New York, United States
- Abushawer, Mohammad Waleed, SUNY Downstate Health Sciences University, New York City, New York, United States
- Jatoi, Tahir Ahmed, SUNY Downstate Health Sciences University, New York City, New York, United States
- Markell, Mariana S., SUNY Downstate Health Sciences University, New York City, New York, United States
- Rochon, Caroline Louise, SUNY Downstate Health Sciences University, New York City, New York, United States
Background
In an effort to improve both equity and utility of organ allocation, the current kidney allocation system (KAS) assigns kidneys from donors with higher kidney donor profile index (KDPI) to recipients with a lower expected posttransplant survival (EPTS) score and vice versa. However, many kidneys with a high KDPI (especially >80%) are discarded for fear of poor outcomes. This study examines our experience with high KDPI kidneys.
Methods
We queried our transplant QI database for all adult primary deceased kidney donor transplants (DDKT) from 2022-2023. The cohort was dichotomized based on high vs lower KDPI (>80% vs.<80%). One-year mortality and allograft failure were compared across groups.
Results
Of 115 DDKT, 81.7% were African-American, 46% were females, median age was 60 years. The recipients with a KDPI < 80% represented 70%. Recipients with a KDPI >80 % were older (66 vs. 57), had longer ischemic times (26.6 hours vs. 23.8 hours) and had a slightly higher EPTS (64% vs. 68%) when compared to the lower KDPI group (table 1). Recipients in the high KDPI group had similar rates of mortality and marginally lower delayed graft function (DGF), these differences were not statistically significant when compared to recipients with a KDPI <80%.
Conclusion
-In keeping with the KAS, organs from donors with KDPI <80% were more likely to be allocated to younger highly sensitized recipients.
-Mortality and graft failure at 1-year pos-transplant did not differ between recipients of KDPI >80% vs. <80% kidneys despite the older age of the high KDPI recipients.
-The high DGF rate in our low KDPI group was likely to be due to our acceptance of allografts from donors with acute kidney injury in an effort to transplant recipients who were ranked lower.
-Our results suggest that high KDPI kidneys should be utilized although the early transplant period requires a strong multidisciplinary transplant team to guarantee good outcomes in underserved communities with low rates of DDKT such as ours.