Outcomes Using High KDPI Kidneys in Recipients Over 65 y of Age

Naeem Goussous; Fransia De Leon; Karima Alghannam; Brian C Howard; Peter A Than; Aileen X Wang; Junichiro Sageshima; Richard V Perez

doi:10.1097/TXD.0000000000001738

Outcomes Using High KDPI Kidneys in Recipients Over 65 y of Age

Transplant Direct. 2024 Nov 15;10(12):e1738. doi: 10.1097/TXD.0000000000001738. eCollection 2024 Dec.

Authors

Naeem Goussous¹, Fransia De Leon¹, Karima Alghannam¹, Brian C Howard¹, Peter A Than², Aileen X Wang³, Junichiro Sageshima¹, Richard V Perez¹

Affiliations

¹ Division of Transplant Surgery, Department of Surgery, University of California Davis, Sacramento, CA.
² Division of Transplant and Hepatobiliary Surgery, Department of Surgery, University of California San Diego, San Diego, CA.
³ Division of Transplant Nephrology, Department of Medicine, University of California Davis, Sacramento, CA.

Abstract

Background: Kidney transplantation has been shown to improve life expectancy when compared with remaining on dialysis. However, there is an ever-expanding shortage of available organs for transplantation. The use of high kidney donor profile index (KDPI; >85) kidneys is 1 strategy to address this shortage. The current study aims to evaluate the advantage of accepting a high KDPI versus a low KDPI kidney (KDPI ≤85) in patients 65 y or older.

Methods: A single-center retrospective review of all patients, ages 65 y or older, who underwent deceased donor kidney transplantation between 2010 and 2020 was performed. Outcomes and wait times of recipients undergoing low KDPI (KDPI ≤85) versus high KDPI (KDPI >85) kidney transplantation were compared. Significance was defined as P < 0.05.

Results: Four hundred ninety-two patients were identified; 317 (64.4%) were men with a median age at transplantation of 69 y. Four hundred five patients received low KDPI kidneys, whereas the remaining received high KDPI grafts. High KDPI kidneys were procured from older donors (60 versus 47, P < 0.001) and had shorter cold ischemic time (25.0 versus 28.3 h, P = 0.01) compared with low KDPI kidneys. There was no significant difference in graft and patient survival between low and high KDPI recipients, with 85.1% and 86.2% grafts functioning at a follow-up of 4.85 (2.9-7.0) y, respectively. Pretransplant wait time was significantly shorter in the high KDPI group (2.7 [1.8-4.1] versus 3.5 [2.3-4.8] y; P = 0.004).

Conclusions: In patients 65 y or older undergoing deceased donor kidney transplantation, high KDPI kidneys may offer shorter pretransplant waiting times without compromising graft or patient survival.