*Purpose: Recent years have seen an increase in the number of kidney transplants (KT) from Maastricht type III asystolic donors, resulting in the acceptance criteria for these organs being widened. Objective: To assess the KDPI score as a risk factor for graft loss in patients with a KT from a deceased donor in type III asystole.

*Methods: This analysis involved 157 KT patients with grafts from type III asystolic donors at our centre from 2010 to 2017. ROC curves were made to show the predictive and discriminatory power of the KDPI in these donors. The Youden index was calculated to determine the point at which the KDPI was the most predictive and discriminatory for death-censored graft loss.

*Results: The mean age of the recipients was 55±13 years and of the donors it was 55±9 years. The cold ischaemia time was 11±4 hours. In all cases the immunosuppression used was induction with thymoglobulin (95%) or basiliximab (5%), steroids, mycofenolate mofetil and tacrolimus. Sixteen patients (10%) lost their graft during the follow-up (22 months; IQR 13-36). The area under the ROC curve of the KDPI to predict graft loss was 67.8% (95% CI, 0.529-0.828; p=0.02). The Youden index showed that a KDPI>90 was the best predictor of censored graft loss. Graft survival at one and three years was significantly lower in patients with a KDPI>90 (86%, 75% vs. 98%, 94%; p=0.007). Bivariate Cox analysis, adjusted for acute rejection, delayed graft function, cold ischaemia time, total warm ischaemia, type of preservation, retransplant, recipient gender and time on dialysis showed that a KDPI>90 was significantly associated with graft loss (Table).

*Conclusions: These results show that the KDPI score has enough sensitivity and specificity to predict the risk of graft loss in patients receiving a kidney from a Maastricht type III donor in asystole. Accordingly, its use should be considered in this type of donor.

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