Background: High kidney donor profile index (KDPI)>85% organs are increasingly discarded, suggesting missed opportunities to provide patients the benefits of transplantation. Herein, we report the experience of high KDPI organs at a single center with high utilization rate of these organs. Methods: All adult deceased donor kidney transplant recipient (KTR) between Jan 2013 and May 2017 were analyzed. We divided KTR in two cohorts by KDPI, either low (≤ 85%) versus high, and examined their outcomes at 6 months by CKD stage. Donor and recipient parameters were studied through a univariate analysis. Kaplan-Meier and log-rank test were used for patient and graft survival. Hazard ratios (HR) were estimated using multivariate Cox proportion hazards regression. Results: We identified 195 low KDPI (mean KDPI 46±24%) and 32 high KDPI KTR (mean KDPI 93±4; p<0.01) with similar mean follow up (low KDPI 828±483 days vs high KDPI 872±414; p=0.69). High KDPI KTRs were older (52±13 yrs vs 64±7; p<0.01), mainly male (62% vs. 84%; p=0.01), more frequently diabetic (33% vs 59%; p<0.01), had shorter dialysis vintage (4.5±3 yr vs 2.8±1.5; p<0.01), longer cold ischemia time (20±7hrs vs 23±5; p=0.01) and higher EPTS (47±29 vs 65±20; p<0.01). There was no significant difference in race, re-transplant, or BMI. 6-month eGFR in high KDPI group was substantially lower (61±19 vs 44±18; p<0.01). One year patient (97% in both) and graft survival (low: 95% vs high: 94%). Interestingly, no difference in estimated 4 yr patient (low KDPI 97% vs. high KDPI 94%; p=0.61) or graft survival (low KDPI 89% vs. high KDPI 81%; p=0.63) was found. CKD stage IV at 6 mo post-transplant correlated with worse graft survival (p=0.011). Recipient age was an additional predictor of graft failure (HR: 0.93, CI: 0.89-0.97; p<0.01) and there was a trend between 6-mo eGFR and graft loss (HR: 0.97, CI: 0.94-1.003; p=0.07). Importantly, KDPI was not predictive of graft failure (HR: 1.02, CI: 0.99-1.04; p=0.17) after adjusting for dialysis vintage, gender, diabetes, BMI, and cold ischemia. Conclusions: Carefully screened high KDPI organs can be successfully used in properly selected recipients with reasonable clinical outcomes. Our data suggests that regardless of KDPI, the eGFR attained at 6 months post-transplant is a key prognosticator of graft outcomes.

CITATION INFORMATION: Agarwal A., Nishio Lucar A., Nickkholgh A., Brayman K., Doyle A., Oberholzer J. Successful Utilization of Deceased Donor Kidney Allografts with KDPI>85: The Organ is Not Wholly to Blame Am J Transplant. 2017;17 (suppl 3).

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