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Survival Benefit of Primary Deceased Donor Transplantation With High‐KDPI Kidneys
Author(s) -
Massie A. B.,
Luo X.,
Chow E. K. H.,
Alejo J. L.,
Desai N. M.,
Segev D. L.
Publication year - 2014
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/ajt.12830
Subject(s) - medicine , transplantation , kidney , surgery
The Kidney Donor Profile Index (KDPI) has been introduced as an aid to evaluating deceased donor kidney offers, but the relative benefit of high‐KDPI kidney transplantation (KT) versus the clinical alternative (remaining on the waitlist until receipt of a lower KDPI kidney) remains unknown. Using time‐dependent Cox regression, we evaluated the mortality risk associated with high‐KDPI KT (KDPI 71–80, 81–90 or 91–100) versus a conservative, lower KDPI approach (remain on waitlist until receipt of KT with KDPI 0–70, 0–80 or 0–90) in first‐time adult registrants, adjusting for candidate characteristics. High‐KDPI KT was associated with increased short‐term but decreased long‐term mortality risk. Recipients of KDPI 71–80 KT, KDPI 81–90 KT and KDPI 91–100 KT reached a “break‐even point” of cumulative survival at 7.7, 18.0 and 19.8 months post‐KT, respectively, and had a survival benefit thereafter. Cumulative survival at 5 years was better in all three high‐KDPI groups than the conservative approach (p < 0.01 for each comparison). Benefit of high‐KDPI KT was greatest in patients age >50 years and patients at centers with median wait time ≥33 months. Recipients of high‐KDPI KT can enjoy better long‐term survival; a high‐KDPI score does not automatically constitute a reason to reject a deceased donor kidney.