Purpose – To study the impact of donor KDPI on post-transplant kidney function and survival.

Methods – We reviewed the records of 309 deceased donor kidney adult recipients who underwent kidney transplant at our center from January 1, 2008 to December 31,2013. We obtained KDPI of the allografts directly from UNOS and patients were divided into the four categories for the new kidney allocation system: KDPI <20, KDPI 20-35, KDPI 36-85, KDPI >85. Demographic data were compared. Kaplan-Meier analysis of patient and graft survival was performed. Graft function at one year of was evaluated by serum creatinine.

Results – A total of 309 recipients received deceased donor kidney transplants from 286 donors over a period of six years. Of the 309 recipients, 48 (5.5%) received kidneys from donors with KDPI <20, 57 (18.4%) from donors with KDPI 20-35, 161 (52.1%) from donors with KDPI 36-85 and 43 (13.9%) from donors with KDPI >85. The mean age of recipients was 55.57 ± 11.6 years. As expected, older recipients were more likely to receive high KDPI kidneys (p=0.025). Recipient gender or race did not differ significantly by group.

Kaplan-Meier analysis did not demonstrate significantly different graft survival by KDPI group. However, graft function did differ significantly at 1 year (p=0.011): 12.8% of KDPI <20 recipients, 9.4% of KDPI 20-35 recipients, 26.2% of KDPI 20-35 recipients and 32.4% of KDPI>85 recipients had Cr greater than 2.0 mg/dL at one year. Similarly, those with severe graft dysfunction varied by groups: 6.4% of KDPI <20 recipients, 5.7% of KDPI 20-35 recipients, 11.5% of KDPI 20-35 recipients and 16.2% of KDPI>85 recipients had Cr greater than 3.0 mg/dL at one year.

Conclusion – With a change in the allocation system and the introduction of KDPI, patients and physicians face new challenges in navigating donor offers. While nation wide data demonstrates a gradual decline in graft survival with increasing KDPI. We know that graft survival is not a clear indicator of graft function. Our study demonstrates that high KDPI grafts behave more like moderate KDPI grafts (KDPI 35-85). Cr greater than 2.0 portends less than ideal long-term graft survival but this outcome is similar amongst all recipients of KDPI greater than 35 allografts. This information may be important as patients and physicians evaluate donor offers.

« Back to 2015 American Transplant Congress