Abstract: TH-PO1004
Modest eGFR Decline and Acceptable Clinical Outcomes in Inactive (Status 7) Kidney Transplant Candidates with Baseline eGFR 15-20 mL/min/1.73 m2: Implications for Deferred Activation
Session Information
- Transplantation: Clinical - Outcomes, Malignancy, and Pathology
October 22, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2002 Transplantation: Clinical
Authors
- Syed, Faizan A., UPMC Harrisburg, Harrisburg, Pennsylvania, United States
- Hoffman, William F., UPMC Harrisburg, Harrisburg, Pennsylvania, United States
- Singh, Manpreet, UPMC Harrisburg, Harrisburg, Pennsylvania, United States
Background
Since the 2003 OPTN policy change allowing wait-time accrual while inactive (Status 7), the proportion of kidney transplant candidates listed as temporarily inactive has risen sharply from 2.3% to over 30% nationally. Population-level analyses show that inactive status is associated with nearly twofold higher waitlist mortality and lower transplantation rates compared with active status. Candidates with eGFR 15-20 mL/min/1.73 m2 are frequently maintained as Status 7 due to adequate residual kidney function to avoid early immunosuppression risks. We evaluated longitudinal eGFR trajectory and clinical outcomes in these patients.
Methods
This single-center retrospective cohort study at UPMC Kidney Transplant Center at Harrisburg included 54 adult candidates listed as Status 7 with baseline eGFR 15-20 mL/min/1.73 m2 (mean 17.6 +/- 1.3) between December 2023 and December 2025. Demographics, comorbidities, serial eGFR, hospitalizations, and adverse events were analyzed. Subgroup analyses compared eGFR change and threshold at 12 and 24 months.
Results
Mean age was 56.6 +/- 12.6 years (67% male, 76% White). Common comorbidities included hypertension (74%), diabetes (46%), and cardiovascular disease (28%). Mean eGFR declined modestly from 17.6 +/- 1.3 to 15.2 +/- 1.1 mL/min/1.73 m2 at 12 months (Delta -2.4) and 14.2 +/- 1.4 at 24 months (Delta -3.2). Median waitlist follow-up time was 23.9 months (IQR 10.5-35.1). Cardiovascular events occurred in 44.4% and a subset progressed to dialysis. Subgroup analyses showed no significant differences in outcomes by eGFR trajectory (p>0.05).
Conclusion
In kidney transplant candidates with baseline eGFR 15-20 mL/min/1.73 m2 maintained as inactive , eGFR declined modestly over 12-24 months without rapid deterioration or major differences in clinical outcomes across eGFR trajectory subgroups. While these data demonstrate the short-term safety of deferred activation in selected patients, population-level evidence indicates that inactive status is associated with substantially higher waitlist mortality. These findings must be weighed against the well-established benefits of preemptive kidney transplantation, which confers superior patient and graft survival and reduced dialysis-associated morbidity. Larger multicenter studies are needed to define optimal activation strategies.