*Purpose: The Collaborative Innovation and Improvement Network (COIIN) was a 3-year OPTN project aimed at increasing the utilization of kidneys with a kidney donor profile index (KDPI) >50%. Using a collaborative framework, overall, the 19 centers that participated in the first cohort of COIIN successfully transplanted a higher volume and proportion of KDPI 51-100% kidneys post COIIN implementation (post COIIN) compared to the same time period a year prior (pre COIIN). To determine if this change had an effect on post-transplant graft survival, this abstract looks at the overall 1-year graft survival for the transplant centers in Cohort A.

*Methods: A Cox Proportional-Hazards model was fit using OPTN data to assess 1-year post-transplant graft survival. Analysis was restricted to adult, kidney-alone deceased donor transplants that took place post COIIN (01/2017 – 09/2017) and pre COIIN (01/2016 – 09/2016), excluding the three months in between to account for transplant seasonality (n = 18,401). The model adjusted for KDPI, as well as other covariates used in the SRTR Kidney Risk Adjustment Models, substituting recipient dialysis time for recipient ESRD time. Survival probabilities from the model were extracted to create Bayesian hazard ratios (HR) and 95% credible intervals (95% CI) of observed to expected graft losses for Cohort A, stratified by pre and post COIIN eras and KDPI groups.

*Results: Adjusted results show a slight increase in the aggregate 1-year graft survival hazard ratio post COIIN compared to pre COIIN for Cohort A, however, the number of observed graft losses remained lower than the expected graft losses (Table 1). A decrease in the KDPI 0-50% 1-year graft survival hazard ratio and an increase in the KDPI >50% 1-year graft survival hazard ratio was observed, but the number of observed graft losses was the same or less than the number of expected graft losses. Survival rates were comparable pre COIIN versus post COIIN for both KDPI groups as well as in the aggregate.

*Conclusions: While participating in the COIIN collaborative framework, Cohort A centers performed an increased number and proportion of higher KDPI transplants while maintaining expected 1-year graft survival outcomes. These results suggest that in the context of collaborative improvement efforts, moderate to high KDPI kidneys can be transplanted without increasing the risk of adverse graft survival outcome evaluation. Further analysis will continue to assess additional COIIN and center level outcomes as well as sustainability of improvement efforts.

« Back to 2019 American Transplant Congress