*Purpose: Since KDPI > 85 donor kidneys have been commonly used among older recipients, renal allograft outcomes of very high KDPI (≥95) donors have been under-reported and associated with a higher discard rate. Increase utilization of those kidneys may be useful for our patients in Southern California where estimate wait time is longer for all blood types. We therefore evaluated renal allograft outcomes at 1 year after transplant with very high KDPI (≥95) comparing with high KDPI (86-94) donor kidneys and analyzed the graft survival after transplant.

*Methods: This retrospective study includes adult patients who received KDPI > 85 donor kidneys transplants in our center between 1/2017-12/2019 in our center and were divided into 2 groups. The very high KDPI group was defined by KDPI ≥95 and high KDPI group with KDPI (86-94). Statistical Analysis was conducted using SPSS program. Values are reported as mean ± standard deviation (SD). Continuous variables were compared using t-test and categorical variables with the Chi- square test, with P < 0.05 considered as statistically significant. The Pearson Correlation Coefficient was used to analyze the relationship between GFR and other variables. The graft survival after transplant was analyzed from the Kaplan-Meire estimate graft survival curve analysis. The outcome endpoints were death, graft failure and study termination.

*Results: Total 73 patients received high KDPI kidneys (>85); while 25 patients received very high KDPI kidney (≥ 95) and 48 patients received high KDPI (86-94), mean age recipients are 65.3±5.9 and 62.72±6.3 p=0.67, BMI at transplant 27.03±5.5 and 26.34±3.8 p=0.1 respectively. No significant differences between recipient characteristics such age, sex race, BMI at transplant, dialysis time, cPRA and CTI. We also found weak negative correlation between age and GFR. No significant differences in DGF rate, GFR at 1 year post transplant between the groups (mean GFR 48.64± 12.1and 49.5±19.8 p=0.85 respectively) and no significant differences between allograft survival from survival analysis (log rank test p=0.92)

*Conclusions: Our study showed no differences in renal outcomes between very high KDPI and high KDPI donor kidneys; therefore the use of very high KDPI may be considered to increase utilization of those kidneys for kidney transplant candidates.

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