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Consequences of Turning Down High KDPI Kidney Organ Offers for Kidney Transplant Candidates

J. D. Motter, L. Liyanage, K. R. Jackson, M. G. Bowring, T. Ishaque, Y. Yu, S. Yu, J. M. Garonzik-Wang, A. B. Massie, D. L. Segev

Johns Hopkins University, Baltimore, MD

Meeting: 2020 American Transplant Congress

Abstract number: 442

Keywords: Allocation, Donors, marginal, Kidney transplantation, Mortality

Session Information

Session Name: Kidney Deceased Donor Selection III

Session Type: Oral Abstract Session

Date: Saturday, May 30, 2020

Session Time: 3:15pm-4:45pm

 Presentation Time: 3:15pm-3:27pm

Location: Virtual

*Purpose: Kidneys with a high Kidney Donor Profile Index (KDPI, 80-100%) are frequently declined as they are associated with higher graft loss; yet, candidates that decline must wait for a future offer that may never come. We sought to characterize outcomes of candidates who declined a high KDPI kidney.

*Methods: We used SRTR data from 2009-2018 to study 149,976 candidates who were offered a high KDPI kidney. We used competing risks regression to characterize the natural history of those who declined, and used adjusted Cox regression to compare the post-decision survival of decliners versus acceptors of high KDPI offers. We used an interaction term to determine whether the survival benefit of acceptance varied across KDPI.

*Results: Among candidates who declined high KDPI kidneys, 45.0% were eventually transplanted, 21.1% died, 20.1% were removed from the waitlist, and 13.6% remained waitlisted (Figure 1). Despite this substantial mortality risk, the survival benefit depended on the KDPI range of the accepted kidney. Acceptors of KDPI 80-95% kidneys experienced a 27% survival benefit compared to decliners (adjusted hazard ratio [aHR]: 0.690.730.77, p<0.001; absolute 5-year risk 18.7% vs. 27.2%) (Figure 2). Moreover, the survival benefit was comparable between KDPI 80-95% (p for interaction >0.05). Conversely, acceptors of KDPI 96-100% experienced a 17% survival benefit compared to decliners (aHR: 0.770.830.89, p<0.001; absolute 5-year risk 22.2% vs. 27.4%) (Figure 3).

*Conclusions: Acceptors of high KDPI kidneys derived a survival benefit, with greater benefit for KDPI 80-95% acceptors. Appropriate selection of high KDPI kidneys may reduce wait-times and improve survival.

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To cite this abstract in AMA style:

Motter JD, Liyanage L, Jackson KR, Bowring MG, Ishaque T, Yu Y, Yu S, Garonzik-Wang JM, Massie AB, Segev DL. Consequences of Turning Down High KDPI Kidney Organ Offers for Kidney Transplant Candidates [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/consequences-of-turning-down-high-kdpi-kidney-organ-offers-for-kidney-transplant-candidates/. Accessed May 11, 2025.

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