Faculty Collaboration Database

Survival Benefit in Older Patients Associated With Earlier Transplant With High KDPI Kidneys. Transplantation 2017 Apr;101(4):867-872

Date

08/09/2016

Pubmed ID

27495758

Pubmed Central ID

PMC5292097

DOI

10.1097/TP.0000000000001405

Scopus ID

2-s2.0-84982836691 (requires institutional sign-in at Scopus site)   112 Citations

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.

Author List

Jay CL, Washburn K, Dean PG, Helmick RA, Pugh JA, Stegall MD

Author

Ryan Helmick MD Associate Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Age Factors
Aged
Chi-Square Distribution
Donor Selection
Female
Graft Survival
Humans
Kaplan-Meier Estimate
Kidney Failure, Chronic
Kidney Transplantation
Male
Middle Aged
Multivariate Analysis
Postoperative Complications
Proportional Hazards Models
Registries
Renal Dialysis
Retrospective Studies
Risk Assessment
Risk Factors
Time Factors
Time-to-Treatment
Tissue Donors
Treatment Outcome
United States
Waiting Lists