Dialysis vintage is an independent predictor of adverse long-term kidney transplant outcomes. Transplantation of "marginal" kidneys also results in inferior outcomes. We sought to analyze how preemptive transplantation of marginal quality kidneys with avoidance of dialysis exposure in older recipients would fare compared to receiving better quality kidney after exposure to varying dialysis vintage. Using OPTN/UNOS database from 2001-2015, we identified deceased donor kidney (DDK) transplant recipients >60 years of age who either underwent preemptive transplantation of kidneys with KDPI ≥ 85% (marginal kidneys) or received kidneys with KDPI of 35-84% (better quality kidneys that older wait-listed patients would likely receive if waited longer) after being on dialysis for either 1-4 or 4-8 years. Using a multivariate Cox model adjusting for donor, recipient and transplant related factors, overall and death-censored graft failure risks along with patient death risk of preemptive transplant recipients were compared to transplant recipients in the 1-4 and 4-8 year dialysis vintage groups. Results are shown in table 1

In summary, our study supports accepting a "marginal" quality high KDPI kidney preemptively in older wait-listed patients thus avoiding dialysis exposure. Such preemptive transplantation results in graft and patient outcomes non-inferior to receiving a better quality kidney with lower KDPI after being on dialysis for a variable period. This practice could come with an added quality of life benefit associated with earlier transplantation and possibly cost benefit. Retrospective design and possibility of residual confounding are study limitations.

CITATION INFORMATION: Chopra B., Hussain S., Sureshkumar K. Kidney Transplantation in Older Recipients: Preemptive High KDPI Kidney vs. Lower KDPI Kidney after Varying Dialysis Vintage Am J Transplant. 2017;17 (suppl 3).

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