Survival Benefit of Deceased Donor Transplantation with High-KDPI Kidneys
Johns Hopkins School of Medicine, Baltimore, MD
Meeting: 2013 American Transplant Congress
Abstract number: 303
The Kidney Donor Profile Index (KDPI) was recently introduced as a metric for quality of DD kidneys. The survival benefit of transplantation with high-KDPI kidneys (high-KDPI KT) is unknown.
This retrospective cohort study of waitlist patients from 2002-2011 compared outcomes after high-KDPI KT to standard treatment (remaining on the waitlist or transplant with a lower-KDPI kidney) using time-dependent Cox regression, adjusting for transplant candidate characteristics. Outcomes were time-varying mortality hazard (time to equal risk) and cumulative mortality (time to equal survival).
Mortality risk increased in the first 30 days after high-KDPI KT, then decreased, becoming statistically significantly lower than standard treatment after 30 days (KDPI 71-80)/180 days (KDPI 81-90 and 91-100). Long-term (>3-year) mortality risk was lower after high-KDPI KT; the difference was statistically significant for KDPI 71-80 (HR=0.70 0.78 0.86, p<=.001) but not for KDPI 81-90 (HR=0.82 0.91 1.01, p=0.1) or KDPI 91-100 (HR=0.86 0.96 1.08, p=0.5).
Greater reduction in long-term mortality risk was observed in centers with longer median wait times. Risk reduction was independent of recipient characteristics.
Ctr median wait time | KDPI 71-80 | KDPI 81-90 | KDPI 91-100 |
<=22 months | 0.80 1.00 1.22 | 0.75 0.97 1.25 | 0.88 1.17 1.55 |
23-33 months | 0.70 0.83 0.98* | 0.90 1.07 1.26 | 0.86 1.04 1.26 |
34-46 months | 0.65 0.80 0.98* | 0.63 0.78 0.96* | 0.77 0.95 1.17 |
>=47 months | 0.41 0.53 0.78* | 0.66 0.81 1.01 | 0.64 0.81 1.01 |
Time to equal survival was 7.9 months post-transpant for KDPI 71-80, 17.7 months post-transplant for KDPI 81-90, and 20.2 months post-transplant for KDPI 91-100. Past these times, high-KDPI KT conferred a net survival advantage.
High-KDPI KT confers net long-term survival advantage due to decreased mortality in the period 0.5-3 years post-transplant. The benefit is greatest at centers with longer wait times.
To cite this abstract in AMA style:
Massie A, Segev D. Survival Benefit of Deceased Donor Transplantation with High-KDPI Kidneys [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/survival-benefit-of-deceased-donor-transplantation-with-high-kdpi-kidneys/. Accessed October 10, 2024.« Back to 2013 American Transplant Congress