Protecting Older Patients from Dialysis: The Survival Benefit of Preemptive Transplant With High KDPI Allografts
1Transplant Center, University of Texas Health Science Center, San Antonio, TX
2Department of Surgery, Division of Transplantation, Mayo Clinic, Rochester, MN.
Meeting: 2015 American Transplant Congress
Abstract number: 292
Keywords: Donors, Elderly patients, Kidney transplantation, marginal, Survival
Session Information
Session Name: Concurrent Session: Kidney: KDPI and Non Ideal Kidneys
Session Type: Concurrent Session
Date: Monday, May 4, 2015
Session Time: 4:00pm-5:30pm
Presentation Time: 4:24pm-4:36pm
Location: Room 118-AB
BACKGROUND: Mortality on dialysis remain markedly elevated in patients over 60 years old. Preemptive kidney transplantation (PreKT) represents a means of avoiding the risks of dialysis. For older patients, accepting a high kidney donor profile index (KDPI) allograft provides increased access to PreKT. However, there is scant evidence regarding the relative benefit of accepting a PreKT from a high KDPI deceased donor. Our aim was to compare the survival benefit of PreKT with a KDPI > 85% graft compared with waiting longer for a non-PreKT with a lower KDPI graft.
METHODS: UNOS data from 2003-2012 for deceased donor kidney transplant (DDKT) candidates and recipients was analyzed. We compared short and long-term patient survival among PreKT and non-PreKT KDPI > 85% recipients >60 years old at transplant, PreKT and non-PreKT KDPI 0-85% recipients >60 years old at listing (based on the hypothesis that patients will wait longer to receive a low KDPI graft), and waitlisted (not transplanted) candidates >60 years old at listing.
RESULTS: In patients > 60 years old, 39% were transplanted over the study period. For DDKT, 13% were PreKT, and 19% of the PreKT were with KDPI >85% grafts. PreKT with KDPI 0-85% grafts had the highest patient survival, but PreKT with KDPI >85% grafts was associated with improved survival compared with non-PreKT with KDPI 0-85% grafts. Three-year survival was 90%, 82%, 88%, and 79% for PreKT with KDPI 0-85%, non-PreKT with KDPI 0-85%, PreKT with KDPI >85%, and non-PreKT with KDPI >85%, respectively (p<0.001). All transplant recipients had improved long-term survival compared with patients who did not get transplanted (3 year survival 75%), but 1 year survival was lower for non-PreKT with KDPI >85% (91%) compared with remaining on the waitlist (93%) (p<0.001).
CONCLUSION: PreKT with KDPI >85% was associated with higher patient survival compared with waiting longer for KDPI 0-85% DDKT in patients > 60 years old. Further consideration should be given to the increased utilization of high KDPI grafts in older patients with the goal of avoiding or limiting dialysis.
| Patient Survival | PreKT KDPI.0-85% (n=2,306) | Non-PreKT KDPI 0-85% (n=14,619) | PreKT KDPI>85% (n=537) | Non-PreKT KDPI >85% (n=4,371) | Waitlist (n=44,591) |
| 1 yr | 96% | 92% | 95% | 91% | 93% |
| 3 yr | 90% | 82% | 88% | 79% | 75% |
| 5 yr | 80% | 70% | 73% | 66% | 57% |
To cite this abstract in AMA style:
Jay C, Washburn K, Dean P, Helmick R, Stegall M. Protecting Older Patients from Dialysis: The Survival Benefit of Preemptive Transplant With High KDPI Allografts [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/protecting-older-patients-from-dialysis-the-survival-benefit-of-preemptive-transplant-with-high-kdpi-allografts/. Accessed May 9, 2025.« Back to 2015 American Transplant Congress