Abstract: SA-PO1051
Short-Term Outcomes in Medically Complex Deceased-Donor Kidney Transplants
Session Information
- Transplantation: Clinical - Postkidney Transplant Outcomes and Potpourri
November 08, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2102 Transplantation: Clinical
Authors
- Nino Torres, Laura, Montefiore Einstein Center for Transplantation, Bronx, New York, United States
- Dilip, Raga, Montefiore Einstein Center for Transplantation, Bronx, New York, United States
- Murthy, Anu, Montefiore Einstein Center for Transplantation, Bronx, New York, United States
- Verzani, Zoe, Weil Cornell, New York, New York, United States
- Jain, Swati, Montefiore Einstein Center for Transplantation, Bronx, New York, United States
- Pynadath, Cindy T., Montefiore Einstein Center for Transplantation, Bronx, New York, United States
- Al Azzi, Yorg, Montefiore Einstein Center for Transplantation, Bronx, New York, United States
- Liriano-Ward, Luz E., Montefiore Einstein Center for Transplantation, Bronx, New York, United States
- Ajaimy, Maria, Montefiore Einstein Center for Transplantation, Bronx, New York, United States
- von Ahrens, Dagny, Montefiore Einstein Center for Transplantation, Bronx, New York, United States
- Abdel Muhdi, Nidal, Montefiore Einstein Center for Transplantation, Bronx, New York, United States
- Yaffe, Hillary C, Montefiore Einstein Center for Transplantation, Bronx, New York, United States
- Le, Marie, Montefiore Einstein Center for Transplantation, Bronx, New York, United States
- Akalin, Enver, Montefiore Einstein Center for Transplantation, Bronx, New York, United States
Background
With national kidney discard rate (30%), transplant centers have considered kidneys from medically complex donors (MCD). We aimed to investigate death-censored graft survival of deceased-donor kidney transplants (DDKT) from MCD: dialysis or final creatinine > 2 mg/dl, DCD and a KDPI ≥ 85%.
Methods
Retrospective analysis of 796 DDKT performed at Montefiore Medical Center between January 2019 and September 2024.
Results
Of the 796 DDKT, 284 were DCD (36%), 66 on RRT (8.3%), 254 with terminal creatinine > 2 mg/dl (32%), 121 with KDPI ≥ 85% (15%), and 103 donor HCV NAT+ (13%). 55% of the kidneys were on pump. 53 patients died (6.6%) and 38 lost their grafts (4.7%) during a median 24 months (IQR 13-24) follow-up. There was no statistically significant difference in terms of patient and donor demographics when graft loss patients are compared to patients with functioning allograft. However, death-censored graft loss patients received more DCD and higher KDPI donors and DGF and acute rejection (AR) rates were higher (Table). In multivariate Cox regression analysis, AR (HR 3.60, CI 1.8-7.22, p < 0.001), DCD (HR 2.23, CI 1.13-4.42, p=0.021) and KDPI (1.02, VI 1.0-1.03, p=0.031) were independent risk factors for graft loss. Surviving patients had excellent kidney function with a median eGFR 59 ml/min (IQR 44,72) at the last follow-up.
Conclusion
While high KDPI and DCD donors were risk factors for death-censored graft loss, our findings indicate that DDKT from MCD have an acceptable short-term outcome. These results suggest that transplant centers may consider expanding organ acceptance criteria to include MCD kidneys, thereby increasing the donor pool.
Table. Donor and recipient variables stratified by death censored graft loss
| Death censored Graft Loss (n=38) | Functioning allograft (n=705) | p-value | |
| KDPI | 74(54,84) | 57(35,77) | 0.005 |
| KDPI ≥85 | 9(24%) | 106(15%) | 0.2 |
| DCD | 20(53%) | 253(36%) | 0.037 |
| HD | 3(7.9%) | 61(8.7%) | >0.9 |
| Donor HCV+ | 6(16%) | 83(12%) | 0.4 |
| Pump | 20(53%) | 386(55%) | 0.8 |
| Donor sCr final (mg/dl) | 1.09(0.74, 2.10) | 1.15(0.72, 2.90) | 0.3 |
| Donor sCr final > 2 (mg/dl) | 11 (29%) | 219 (31%) | 0.2 |
| DGF | 28 (74%) | 344 (49%) | 0.003 |
| Acute rejection | 12 (32%) | 54 (7.7%) | |
n(%); Median(Q1, Q3)