Obese patients have less access to kidney transplantation; use of high-KDPI kidneys could help expand access in this population, but the cumulative effect of obesity and high-KDPI could be prohibitive. The goal of this study was to explore long-term survival benefit of receiving a high-KDPI kidney in obese patients versus waiting for a lower-KDPI kidney.

METHODS: Using 2005-2014 SRTR data we identified 71,525 KT waitlist candidates with BMI >30 and estimated survival benefit of receiving a high-KDPI kidney versus waiting for a lower-KDPI using Cox regression and the Mauger method, calculating time to equal survival and time to equal hazard of death.

RESULTS: Of those transplanted 2,445 (9.8%) received a 71-80 KDPI kidney, 2,082 (8.3%) received an 81-90 KDPI kidney and 1,421 (5.7%) received a 91-100 KDPI kidney. Post-KT time to equal risk was 4.9 months for recipients of KDPI 71-80 kidneys, 5.6 months for recipients of KDPI 81-90 kidneys, and 4.3 months for recipients of KDPI 91-100 kidneys. Time to equal survival was 8.5 months among recipients of KDPI 71-80, 14.5 months among recipients of KDPI 81-90 and 20.9 months among recipients of KDPI 91-100. Four years post-DDKT cumulative mortality was 32%, 22% and 7% lower in recipients of 71-80, 81-90 and 91-100 KDPI kidneys, respectively.

CONCLUSION: Following a high risk period immediately post-DDKT, obese patients who accepted high-KDPI kidneys had decreased cumulative mortality when compared to those who waited on the list for a lower-KDPI kidney. Increased utilization of high-KDPI kidneys could expand the kidney supply and improve outcomes for obese kidney transplant candidates.

CITATION INFORMATION: Bowring M, Massie A, Luo X, Segev D. Survival Benefit of High-KDPI Kidneys Among Obese Transplant Candidates. Am J Transplant. 2016;16 (suppl 3).

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