Background: High kidney donor profile index (KDPI >85%) organs can grant earlier access to transplantation particularly for those who are frail, have limited waiting time and/or unfavorable blood type. We sought to investigate the outcomes of high KDPI recipients at a center with high utilization rate. Methods: All adult deceased donor kidney transplant older recipients (age≥60) from a single center institution between Jan 2013 and May 2017 were analyzed. KTR were divided in two by KDPI, either low (≤85%) or high, and examined the outcomes by CKD stage at 6 months. Donor and recipient pre and post-transplant parameters were analyzed through a univariate manner. Survival analysis was done by Kaplan-Meier and log-rank test were used for patient and graft survival. Multivariate Cox proportion hazards regression was used to estimate hazard ratios (HR). Results: There were 42 low KDPI (mean KDPI 59±17%) and 24 high KDPI KTR (mean KDPI 93±4; p<0.01) with similar follow up (low KDPI 2.6±1.4 years vs high KDPI 2.4±1.1; p=0.52). Cohorts were well matched; age (low 66±5 years vs 66±5; p=0.52), mainly male (76% vs. 83%; p=0.74), similar DM (37% vs. 41%; p=0.84), and equivalent EPTS (76±17 vs. 69±17; p=0.12). High KDPI had shorter dialysis vintage (3.8±2.5 years vs 2.8±1.6; p=0.05), longer cold ischemia time (20±5hrs vs. 23±5; p=0.04). There was no significant difference in race, re-transplant, or BMI. 6-month eGFR in the high KDPI group was substantially lower (59±17 ml/min/m² vs 44±16; p<0.01) with differences in CKD stage distribution (% CKD stage 2: low 33% vs 5%) and (%CKD stage 3: low 59% vs 81%; p=0.01). There were trends for lower estimated 4 year patient (low KDPI: 100% vs. high KDPI 92%; p=0.08) and 4 year graft survival (low: 95% vs high: 88%; p=0.1). Six month CKD stage did not impact graft survival (p=0.78). Neither 6 month GFR (HR: 0.97, CI: 0.91-1.04; p=0.41) nor KDPI (HR: 1.02, CI: 0.97-1.06; p=0.47) were predictive of graft survival after adjusting for dialysis vintage, gender, diabetes, BMI, DGF, and cold ischemia. Conclusions: Elderly kidney transplant candidates can be efficiently and timely transplanted using high KDPI organs without major compromise of their clinical outcomes. High KDPI organ utilization among this population should be further expanded.

CITATION INFORMATION: Nickkholgh A., Agarwal A., Nishio Lucar A., Brayman K., Doyle A., Oberholzer J. Successful Utilization of Deceased Donor Kidney Allografts with KDPI>85 in Older Recipients Am J Transplant. 2017;17 (suppl 3).

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