Date: Monday, May 4, 2015
Session Name: Concurrent Session: Kidney: KDPI and Non Ideal Kidneys
Session Time: 4:00pm-5:30pm
Presentation Time: 4:24pm-4:36pm
Location: Room 118-AB
BACKGROUND: Mortality on dialysis remain markedly elevated in patients over 60 years old. Preemptive kidney transplantation (PreKT) represents a means of avoiding the risks of dialysis. For older patients, accepting a high kidney donor profile index (KDPI) allograft provides increased access to PreKT. However, there is scant evidence regarding the relative benefit of accepting a PreKT from a high KDPI deceased donor. Our aim was to compare the survival benefit of PreKT with a KDPI > 85% graft compared with waiting longer for a non-PreKT with a lower KDPI graft.
METHODS: UNOS data from 2003-2012 for deceased donor kidney transplant (DDKT) candidates and recipients was analyzed. We compared short and long-term patient survival among PreKT and non-PreKT KDPI > 85% recipients >60 years old at transplant, PreKT and non-PreKT KDPI 0-85% recipients >60 years old at listing (based on the hypothesis that patients will wait longer to receive a low KDPI graft), and waitlisted (not transplanted) candidates >60 years old at listing.
RESULTS: In patients > 60 years old, 39% were transplanted over the study period. For DDKT, 13% were PreKT, and 19% of the PreKT were with KDPI >85% grafts. PreKT with KDPI 0-85% grafts had the highest patient survival, but PreKT with KDPI >85% grafts was associated with improved survival compared with non-PreKT with KDPI 0-85% grafts. Three-year survival was 90%, 82%, 88%, and 79% for PreKT with KDPI 0-85%, non-PreKT with KDPI 0-85%, PreKT with KDPI >85%, and non-PreKT with KDPI >85%, respectively (p<0.001). All transplant recipients had improved long-term survival compared with patients who did not get transplanted (3 year survival 75%), but 1 year survival was lower for non-PreKT with KDPI >85% (91%) compared with remaining on the waitlist (93%) (p<0.001).
CONCLUSION: PreKT with KDPI >85% was associated with higher patient survival compared with waiting longer for KDPI 0-85% DDKT in patients > 60 years old. Further consideration should be given to the increased utilization of high KDPI grafts in older patients with the goal of avoiding or limiting dialysis.
|Patient Survival||PreKT KDPI.0-85% (n=2,306)||Non-PreKT KDPI 0-85% (n=14,619)||PreKT KDPI>85% (n=537)||Non-PreKT KDPI >85% (n=4,371)||Waitlist (n=44,591)|
To cite this abstract in AMA style:Jay C, Washburn K, Dean P, Helmick R, Stegall M. Protecting Older Patients from Dialysis: The Survival Benefit of Preemptive Transplant With High KDPI Allografts [abstract]. Am J Transplant. 2015; 15 (suppl 3). http://atcmeetingabstracts.com/abstract/protecting-older-patients-from-dialysis-the-survival-benefit-of-preemptive-transplant-with-high-kdpi-allografts/. Accessed September 26, 2017.
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