*Purpose: To evaluate the impact of High Kidney Donor Profile Index (KDPI) on 1-year post-transplant renal function and graft survival.

*Methods: This retrospective cohort analyzed 3,059 deceased donor kidney transplants performed between January 2013 and December 2017 in a high-volume center in Brazil. They were divided into 4 groups according to KDPI values: Group A-KDPI 0-35 (n=561), Group B-KDPI 36-50 (n=361), Group C-KDPI 51-85 (n=1,289), and Group D-KDPI >85 (n=848) and were followed during the first year post-transplantation. GFR was estimated according to the CKD-EPI formula. Sensitive analysis of GFR used last observation carried forward imputation method for death and set at 0 ml/min/1.73m² for graft loss.

*Results: Recipients of kidneys with KDPI>85% were older and more frequently had hemodialysis as previous treatment. A higher proportion received kidneys from older, non-black, and female donors with hypertension and diabetes. Median cold ischemia time was similar and high in all groups (23h; p=0.513). The incidence of DGF were A=50.6%, B=59.3%, C=62.7% and D=62.0% (p<0.001). Median GFR were A=64.8 (50.1-82.4), B=53.3 (38.8-68.6), C=46.9 (34,5-59.6) and D=39.1 (26.8-50.5) ml/min/1.73m² (p<0.001), respectively (Figure 1). Biopsy-proven acute rejection (A=9.1%, B=9.8%, C=8.4%, D=9.1%, p=0.736) and graft survival (A=93.6%, B=91.1%, C=92.7%, D=90.0%, p=0.051) were similar between groups. In the ROC curve, increased values of KDPI were correlated to GFR <50ml/min/1.73m² with an AUC of 0.702 (IC 95% 0.684-0.721; p<0.001). In multivariate analysis, increased values of KDPI were related to GFR <50ml/min/1.73m² (OR 1.23; CI 95% 1.02-1.026; p<0.001).

*Conclusions: In a single-center cohort of deceased donor kidney transplants with high cold ischemia time and high incidence of DGF, KDPI is correlated to GFR at 1-year post-transplantation. The median values of GFR were lower among those with high KDPI. Besides that, 1-year graft survival was similar between groups

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