Pursuit of donation after cardiac death (DCD) organ donors requires a significant investment in resources. As an Organ Procurement Organization which very aggressively pursues such donors, we have questioned the utility of DCD donors who might be "high risk" for a failed allocation, such as those with high kidney donor profile index (KDPI) AND advanced age.

Purpose: To explore the impact of KDPI and age on DCD kidney donation on a national level.

Methods: Data were queried from UNOS, targeting DCD kidney donors from Jan 1, 2006 to June 30, 2016, comprising 11434 DCD organ donors. Results were evaluated by cohorts of age (18-50, 51-60, and 60+ yrs) and KDPI (0-85% [low] and 86-100% [high]). Kidney discards rates, delayed allograft function (DGF) and allograft survival were of particular interest.

Results: There were modest differences in discard rates among age groups in DCD donors with respect to KDPI. In the high KDPI group, donors 18-50 yrs had the highest discard rate (58.3%), while donors 51-60 and 60+ yrs had slightly lower discard rates (54.3% and 54.1%, respectively).

For DGF, high KDPI donors of young age (18-50 yrs) experienced DGF at a rate of 53.7%, while DGF for low KDPI donors from this age group was 39.3%. Similarly, DGF for donors 51-60 yrs was 52.3% for KDPI ≥ 86 and 48.1% for KDPI < 85. In the oldest age group there was also not a marked difference in DGF between the KDPI cohorts: 48.9% (high KDPI) vs 47.1% (low KDPI).

One yr death-censored allograft survival demonstrated a less than 10% difference between the KDPI groups, regardless of donor age:

Interestingly, when death-censored 1 yr allograft survival was adjusted for donors with a serum creatinine ≥ 1.5 mg/dL, the low KDPI cohort had a 1 yr survival of 94.4% for donors aged 18-50, and 93.3% for donors aged 51-60. For kidney donors with KDPi ≥ 86 and a terminal creatinine > 1.5 mg/dL, 1 yr allograft survival was 85.9% for the 18-50 yr group, and 86.5% for the 51-60 yr group.

Conclusion: Donor age and KDPI appear to have minimal effects on DGF and 1 yr allograft survival in transplanted DCD kidneys, even for donors with compromised renal function. The aggressive pursuit of DCD donors, regardless of age and KDPI, can result in more kidney transplants without a pronounced compromise in function.

CITATION INFORMATION: Rogge J., Hostetler C., Nicely B., Rudich S. Aggressive Pursuit of Donation after Cardiac Death Kidney Donors with High Kidney Donor Profile Index: Good Use of Resources? Am J Transplant. 2017;17 (suppl 3).

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