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Survival Benefit in Older Patients Associated With Earlier Transplant With High KDPI Kidneys

Jay, Colleen L. MD, MS; Washburn, Kenneth MD; Dean, Patrick G. MD; Helmick, Ryan A. MD; Pugh, Jacqueline A. MD; Stegall, Mark D. MD

doi: 10.1097/TP.0000000000001405
Original Clinical Science-General

Background: Given high dialysis mortality rates for patients older than 60 years, accepting a kidney with a high Kidney Donor Profile Index (KDPI) score could enable earlier and potentially preemptive transplantation (preKT). However, evidence regarding the risks of high KDPI allografts in older patients is limited. Our objective was to determine the relative benefit for older patients of KDPI greater than 85% transplant either preemptively or not compared with remaining on the waitlist.

Methods: United Network of Organ Sharing data from 2003 to 2012 for adult deceased donor kidney transplant candidates was analyzed to evaluate patient survival in patients older than 60 years for preKT and non-preKT KDPI greater than 85% transplants compared with candidates remaining on the waitlist including patients who received KDPI 0% to 85% transplants according to multivariate Cox regression models.

Results: In the first year posttransplant for KDPI greater than 85% of transplants in recipients older than 60 years, preKT had a reduced mortality hazard (hazards ratio [HR], 0.61; 95% confidence interval [95% CI], 0.41-0.90) and non-preKT an increased mortality hazard (HR, 1.15; 95% CI, 1.03-1.27) compared with the waitlist including KDPI 0% to 85% transplant recipients. At 1 to 2 years and after 2 years, both KDPI greater than 85% groups had significant reductions in mortality (1-2 years: preKT HR, 0.38; 95% CI, [0.23-0.60] and non-preKT HR, 0.52; 95% CI, 0.45-0.61; and 2+ years: preKT HR, 0.50; 95% CI, 0.38-0.66 and non-preKT HR, 0.64; 95% CI, 0.58-0.70, respectively).

Conclusions: PreKT and non-preKT KDPI greater than 85% transplant was associated with lower mortality hazard after the first year compared with the waitlist including KDPI 0% to 85% transplants in patients older than 60 years. Further consideration should be given to increased utilization of high KDPI grafts in older patients with the goal of avoiding or limiting time on dialysis.

This analysis of UNOS registry data shows, in end-stage renal disease candidates for kidney transplantation, that by 2 years after kidney transplant, recipients of transplants with a KDPI >85% had a lower mortality than those remaining on the waitlist and those who received a preemptive transplant had the lowest mortality.

1 Transplant Center, University of Texas Health Science Center, San Antonio, TX.

2 Division of Transplant Surgery, Mayo Clinic, Rochester, MN.

3 Methodist University Hospital Transplant Institute, University of Tennessee Health Science Center, Memphis, TN.

4 South Texas Veterans Health Care System, San Antonio, TX.

5 Division of Hospital Medicine, University of Texas Health Science Center, San Antonio, TX.

Received 12 February 2016. Revision received 22 June 2016.

Accepted 24 June 2016.

The project described was supported by the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant KL2 TR001118. J.A.P.'s salary is supported by the Department of Veterans Affairs. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the Department of Veterans Affairs.

The authors declare no conflicts of interest.

C.J. participated in conception or design of the work, analysis and interpretation of data, drafting and revision of the article. K.W. participated in conception or design of the work, interpretation of data, drafting and revision of the article. P.D. participated in the interpretation of data, drafting, and revision of the article. R.H. participated in drafting and revision of the article. J.P. participated in conception or design of the work, interpretation of data, drafting and revision of the article. M.S. participated in conception or design of the work, interpretation of data, drafting and revision of the article.

Correspondence: Colleen Jay, MD, Transplant Center, University of Texas Health Science Center, 7703 Floyd Curl Dr., San Antonio, TX 78229. (jay@uthscsa.edu).

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