Introduction: With the development of the Kidney Donor Profile Index (KDPI) and a new Kidney Allocation System (KAS) implemented on 12/4/14, the expanded criteria donor (ECD) era ended and was supplanted by high KDPI donor kidneys (KDPI ≥85%). High KDPI kidneys increase the organ pool but discard rates remain high as their relative value has been questioned based on projected lower long-term survival outcomes. The study purpose was to retrospectively review our experience with high KDPI kidney transplants (KTs). Methods: All patients received depleting antibody induction with tacrolimus/mycophenolate ± steroids. Standardized management algorithms were implemented to preserve nephron function (including machine preservation) and recipient selection was based on low immunological risk (low PRA level), predicted limited nephron need (older age, lower BMI) and informed consent. Results: From 2003-2016, we performed 272 KTs from high KDPI donors. 145 kidneys (53.3%) were imported from other donor service areas. Overall mean cold ischemia time was 27 hours; 87% were pumped. Study groups were sub-categorized as KDPI 85-89% (n=83), 90-94% (n=99), and 95-100% (n=90). Mean donor and recipient ages in the 3 groups were 57 and 61, 61 and 63, and 67 and 67 years, respectively (p<0.05). Number of dual KTs across groups were 2, 13, and 23, respectively (p<0.001). With a mean follow-up of 6 years, patient survival (PS) rates were 70%, 78%, and 71%, whereas graft survival (GS) rates were 52%, 65%, and 62%, respectively. The incidences of primary non-function (PNF) and delayed graft function were 4.8% and 32.5%, 4% and 29%, and 9% and 31%, respectively (p=0.17 for PNF). There were no differences in outcomes between import and local high KDPI donor KTs, although the incidence of PNF was higher with imported kidneys (8.3% vs 3.7%, p=0.19). Conclusion: By appropriate donor and recipient profiling and the use of management algorithms to project and preserve renal function (including dual KTs), acceptable and comparable intermediate-term outcomes can be achieved with high KDPI donor kidneys regardless of donor origin or high KDPI sub-category, suggesting that broader sharing of these kidneys may improve utilization without compromising outcomes within the limitations of cold ischemia.

CITATION INFORMATION: Harriman D., Farney A., Rogers J., Orlando G., Reeves-Daniel A., Gautreaux M., Doares W., Kaczmorski S., Stratta R. High Kidney Donor Profile Index (KDPI) Donor Kidneys: Use Them, Don't Lose Them! Am J Transplant. 2017;17 (suppl 3).

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