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High KDPI Kidneys: Lifelong Freedom from Dialysis for Elderly Patients

M. M. Romine1, W. Irish2, H. Jones3, A. Aaron2, D. Leeser4

1Department of Surgery, Eastern Carolina University, Greenville, NC, 2Eastern Carolina University, Greenville, NC, 3Eastern Nephrology Associates, Greenville, NC, 4East Carolina University, Greenville, NC

Meeting: 2022 American Transplant Congress

Abstract number: 750

Keywords: Donors, marginal, Elderly patients, Graft survival, Kidney

Topic: Clinical Science » Kidney » 32 - Kidney Deceased Donor Selection

Session Information

Session Name: Kidney Deceased Donor Selection

Session Type: Poster Abstract

Date: Saturday, June 4, 2022

Session Time: 5:30pm-7:00pm

 Presentation Time: 5:30pm-7:00pm

Location: Hynes Halls C & D

*Purpose: According to national data, there is an increase in kidney transplants in patients over 65, corresponding to an overall general increase. Elderly patients continue to be transplanted at lower rates than others. This is likely due to factors including stringent selection criteria, decreased interest among older patients or a perception of limited utility of transplantation in the elderly. Using data from a rural kidney transplant population in eastern North Carolina, we evaluated long-term graft survival among elderly recipients of deceased and living donor transplants.

*Methods: A single center study from a transplant program in eastern North Carolina was performed by collecting data from a total 1524 kidney transplant patients. The transplant period was between 1995 and 2020. Patients were stratified into two categories, age below 65 (Group 1) and age older than 65 (Group 2). Donor and recipient characteristics were compared between age groups using the two-sample t-test or chi-square test, where appropriate. Graft survival (time to graft loss/death) was estimated using the Kaplan-Meier method, while the probabilities of graft loss and death were estimated using the cumulative incidence function. Multivariable Cox’s cause-specific hazard model was used to evaluate the association of age group with risk of graft loss/death. Hazard ratio (HR: Group 2 vs Group 1) and 95% confidence interval (CI) are provided.

*Results: Organs for recipients over 65 were more likely to be older, have higher KDPI (>85%), qualify as ECD, as well as have a history of hypertension/diabetes (Table 1). One-, 5- and, 10 year graft survival rates were 92%, 62% and 32%, respectively in Group 2 compared to 93%, 74% and 49% in Group 1 (<0.001). Probability of graft loss/death at 1-, 5- and 10-years post-transplant was 3%/6%, 8%/30%, and 13%/55% in Group 2 compared to 4%/3%, 15%/11%, and 27% /24% in Group 1. Adjusted HR for death-censored graft loss for Group 2 vs Group 1 was 0.626 (95% CI: 0.407,0.960; p=0.032). When looking at risk of death with functioning graft, the adjusted HR was 2.481 (95% CI: 1.937, 3.178).

Recipient Age at Transplant
Age<65
(Group 1:n=1291)
Age >= 65
(Group 2: n=233)
P-value
Donor-characteristics
Deceased Donor 67.5% 76.4% 0.007
Mean donor age (SD) 38.7 (14.7) 47.9 (15.4) <0.001
Hypertension 0.2 0.4 <0.001
Mean terminal SCr (SD) 1.2 (0.8) 1.2 (0.7) 0.152
ECD 13.5% 37.6% <0.001
Mean KDPI (SD) 0.45 (0.30) 0.63 (0.30) <0.001
KDPI > 85% 9.6% 31.1% <0.001
DCD 15.6% 23.6% 0.012
Mean Cold ischemia time (hours)(SD) 21.5 (7.3) 20.9 (8.5) 0.396
Recipient characteristics
Mean age (SD) 47.9 (11.2) 68.3 (2.8) <0.001
Female 42.1% 48.1% 0.0984
Black 67.0% 55.8% <0.001
Diabetes 37.7% 32.7% <0.001
Mean total HLA mismatches (SD) 3.7 (1.7) 4.0 (1.5) 0.013
DGF 15.3% 19.7% 0.098

*Conclusions: The majority of elderly recipients with graft failure were due to death with a functioning graft. Future areas to explore are the reasons for cause of death in this population. This study also demonstrates that organs that are typically considered marginal (older age, ECD, higher KDPI) can successfully be used in the elderly population and may help reduce the organ discard rate.

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To cite this abstract in AMA style:

Romine MM, Irish W, Jones H, Aaron A, Leeser D. High KDPI Kidneys: Lifelong Freedom from Dialysis for Elderly Patients [abstract]. Am J Transplant. 2022; 22 (suppl 3). https://atcmeetingabstracts.com/abstract/high-kdpi-kidneys-lifelong-freedom-from-dialysis-for-elderly-patients/. Accessed June 6, 2025.

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