Abstract: FR-PO0959
Are High-Kidney Donor Profile Index (KDPI) Kidneys Equitably Allocated? A National UNOS-STAR Cohort Study
Session Information
- Transplantation: Clinical - Pretransplantation, Living Donation, and Policies
November 07, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2102 Transplantation: Clinical
Authors
- Cojuc, Gabriel, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
- Rivera, Maria Belen, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
- Canizares Quisiguina, Stalin Isaias, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
- Posso, Agustin Nicolas, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
- Sureshkumar, Kalathil K., Allegheny Health Network, Pittsburgh, Pennsylvania, United States
- Dib, Martin, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
- Pavlakis, Martha, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
- Parker, William F, The University of Chicago, Chicago, Illinois, United States
- Chopra, Bhavna, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
Background
High-KDPI (>85%) kidney transplantation (KT) is a way to increase the donor pool with acceptable outcomes. It is unclear how these kidneys are allocated across racial/ethnic groups. We assessed the association between race/ethnicity and the allocation of high-KDPI kidneys in the U.S.
Methods
UNOS-STAR file analysis of adult kidney waitlist candidates (WLC) from 1/1/2015–6/30/2023. The outcome measures were the odds of willingness to accept a high-KDPI kidney using multivariable logistic regression; time-to-event likelihood of receiving a high-KDPI KT by race/ethnicity using an adjusted Fine-Gray competing risks model; and waitlist time differences by race/ethnicity and KDPI category using multivariable linear regression.
Results
Of 279,448 WLC, 44.2% were willing to accept a high-KDPI kidney, with Black and Hispanic WLC with higher odds (willing to accept) vs. White WLC. (Fig 1a) Only 1.8% of the list received high-KDPI KT (age 65.0±8.4 years), representing 1.6% White, 2.1% Black, 1.6% Hispanic, and 2.2% Asian WLC. Compared to White WLC, the adjusted subdistribution hazard ratio (95%CI) of receiving a high-KDPI KT was higher in Black 1.73 (1.62–1.86), Hispanic 1.38 (1.26–1.50), and Asian 1.54 (1.39–1.71) WLC. Across all races/ethnicities, receiving a high-KDPI KT vs. non-High KDPI KT was associated with shorter waitlist times; adjusted mean difference (AMD) (95%CI) -262.8 (-294.4 – -231.4) days. Non-White high-KDPI KT recipients had longer waitlist times than White high-KDPI KT recipients; AMD 321.8 (277.5–366.2) days. (Fig 1b)
Conclusion
Compared to White WLC, individuals from other racial/ethnic groups had both higher odds of willingness to accept and a higher likelihood of receiving a high-KDPI KT. Although high-KDPI KT was associated with shorter waitlist times, non-White high-KDPI KT recipients had longer waitlist times than their White counterparts. These findings suggest structural factors may contribute to inequitable high-KDPI kidney allocation warranting further investigation and intervention.
Figure 1