Background:

The kidney donor profile index (KDPI) helps discern kidney function. While recipients must consent for KDPI >85% kidneys, clinicians often decide whether to accept KDPI 71-85% offers, specifically for young, healthy patients. Older patients with prolonged wait times have been shown to benefit from these kidneys; yet other patients may face equipoise or harm. We sought to analyze the effect of accepting a kidney with KDPI 71-85% versus waiting for a better offer among different age, diabetic and wait time cohorts.

Methods:

The SRTR database was used to analyze first-time recipients of solitary, kidney-only cadaveric renal transplants from 2006-2016. Using time-dependent regression, an exposed cohort of patients who received KDPI 71-85% transplants (higher KDPI) were compared to a cohort who either remained on the waitlist, or received KDPI <71% transplants. Patients were followed until death, graft failure, or the end of the study period. Subgroup analysis was performed among different age, wait time and diabetic cohorts. A cumulative ratio analysis was used to assess the hazard associated with higher KDPI transplant in specific scenarios.

Results:

237,541 patients were included in the study. There was a significantly decreased risk of death or graft failure over the study period in the higher KDPI cohort (HR 0.394, p<0.001). This benefit remained true over all age, diabetic, and wait time subgroups. Cumulative ratio analysis failed to demonstrate a scenario where a conservative approach showed benefit over higher KDPI transplantation.

Conclusions:

Among all analyzed scenarios, recipients benefit from higher KDPI transplantation. Practitioners should consider transplanting these kidneys rather than waiting for better offers.

CITATION INFORMATION: Grodstein E., Yang J., Nair V., Molmenti E., Teperman L. The Benefit of Higher KDPI Renal Transplantation over Waiting for a Better Offer Am J Transplant. 2017;17 (suppl 3).

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