In December 2014, UNOS implemented broad changes in the new Kidney Allocation System (KAS). Recent UNOS summary reports suggest that nationally, organ discard rates have increased, especially from donors with kidney donor profile index (KDPI) >85, suggesting missed opportunities to provide patients the survival benefit of transplantation. The purpose of this study was to evaluate the utilization of KDPI >85 organs at a single center.

This was a retrospective single center cohort study of adult deceased donor kidney transplant recipients (KTRs) receiving a KDPI>85 organ from 2013 to 2016. Cohorts were stratified before and after KAS implementation (PRE and POST). Univariate analysis was performed for donor and recipient parameters. Patient and graft survival were analyzed with Kaplan-Meier and log-rank test.

Of the 180 KTRs performed during this time period, 28 utilized KDPI>85 organs. There was no statistical difference in utilization rates of KDPI>85 organs between cohorts (9 (13%) PRE vs. 19 (17%) POST, p=0.53). Baseline demographics were similar between groups including: age (61±8 vs. 65±6; p=0.22), cause of renal disease, %female (18% vs. 11%; p=0.57), race, and DR mismatch. There was a trend towards higher EPTS scores in the POST cohort (58±22 vs. 70±20; p=0.14). The POST cohort had significantly lower BMIs (30±2 vs. 27±5; p=0.049). Of note, no patients were highly sensitized with PRA>98%. There was no differences in mean KDPI (93±3 vs. 93±4; p=0.95) nor cold times (21±5 hours vs. 24±4; p=0.15). Overall, one year patient survival was 100% with only one graft loss (0% vs. 5%; p=0.82) secondary to vascular thrombosis. Renal function (eGFR) was improved in the POST cohort at 6 months (32±10 vs. 48±18; p=0.006) and 12 months (31±8 vs. 47±20; p=0.04). More importantly, a greater percentage of POST patients had an eGFR corresponding to CKD ≤ stage 3 (66% vs 83%). Patients with KDPI>85 organs had significantly shorter dialysis exposure vs. those with KDPI<85 organs (1006±556 vs. 1642±1029 days; p<0.001), representing a nearly 2 year reduction of dialysis morbidity.

High KDPI organs can be successfully used in the elderly patient population with excellent clinical outcomes exceeding the KDPI model predicted ones. The data would suggest that there was more appropriate donor-recipient matching (increase in EPTS) and improved renal function due to recipients with lower BMIs. Individual centers should assess their high KDPI organ experience to improve patient survival and organ allocation.

CITATION INFORMATION: Agarwal A, Ally W, Brayman K. Successful Utilization of Deceased Donor Kidney Allografts with KDPI>85: A Single Center Experience. Am J Transplant. 2017;17 (suppl 3).

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