Session Name: Kidney Deceased Donor Allocation
Session Date & Time: None. Available on demand.
*Purpose: Some studies have suggested Black kidney transplant recipients have an increased incidence of graft failure and worse survival. We examined whether this finding is consistent using a cohort of recipients of high KDPI (gt85%)/lower quality grafts.
*Methods: National data (UNOS) and Multivariable Cox Models were used to assess death-censored graft failure and survival at 1-year post kidney transplant.
*Results: 2,845 adults who received a deceased donor kidney only (multiorgan excluded) categorized as high KDPI >85% for the first time (6/1/2015 to 6/1/2018) met inclusion criteria. 984 (35%) were White, 997 (35%) were Black, 583 (20) were Hispanic and 281 (10%) were Asian. The median KDPI for Whites was 90% (IQR 87%-94%), Blacks 90% (IQR 87%-94%), Hispanics 90% (IQR 87%-93%) and Asians 89% (IQR 87-93). The median EPTS score for Whites was 74% (IQR 56%-89%), Blacks 75% (IQR 51%-91%), Hispanics 81% (61%-91%) and Asians 77% (58%-91%). Graft failure rate for Whites was 7%, Blacks 7%, Hispanics 4% and Asians 5%. Survival for Whites was 93%, Blacks 95%, Hispanics 94% and Asians 95%. After adjusting for age, gender, insurance, education level, cause of renal failure, waiting time, number of HLA mismatches and cold ischemic time there were no racial differences in death censored graft failure. Black vs White [HR 0.89 (95% CI 0.6-1.3)]; Hispanic vs White [HR 0.63 (95% CI 0.4-1.1)] and Asian vs White [HR 0.69(95%CI 0.4-1.2)]. Similarly, after adjusting for EPTS score, BMI, gender, insurance, education level and cold ischemic time no racial differences in 1-year survival were observed. Black vs White [HR 0.80 (95% CI 0.6-1.2)]; Hispanic vs White [HR 1.1 (95% CI 0.7-1.7)] and Asian vs White [HR 0.82 (95%CI 0.5-1.5)].
*Conclusions: Concern for poorer outcomes among Black recipients of high KDPI kidneys may be unwarranted at least in the short-term. Greater utility can be made of high KDPI kidneys for which survival benefit has been demonstrated yet are still discarded at a high rate.
To cite this abstract in AMA style:Atiemo K, Guisti S, Guo K, Amankonah T, Vijay A, Paramesh A, Killackey M, Jeon H, Zhao L, Ladner D. Black Patients Do Not Have Worse Short-Term Outcomes After Receiving High KDPI (>85%) Kidneys [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/black-patients-do-not-have-worse-short-term-outcomes-after-receiving-high-kdpi-85-kidneys/. Accessed June 16, 2021.
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