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Transplantation. 2017 Apr;101(4):867-872. doi: 10.1097/TP.0000000000001405.

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

Author information

1
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.

Abstract

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.

PMID:
27495758
PMCID:
PMC5292097
DOI:
10.1097/TP.0000000000001405
[Indexed for MEDLINE]
Free PMC Article

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