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High mortality in diabetic recipients of high KDPI deceased donor kidneys
Author(s) -
Pelletier Ronald P.,
Pesavento Todd E.,
Rajab Amer,
Henry Mitchell L.
Publication year - 2016
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.12768
Subject(s) - medicine , diabetes mellitus , dialysis , coronary artery disease , body mass index , kidney , proportional hazards model , retrospective cohort study , surgery , artery , cardiology , myocardial infarction , endocrinology
Background Deceased donor (DD) kidney quality is determined by calculating the Kidney Donor Profile Index (KDPI). Optimizing high KDPI (≥85%) DD transplant outcome is challenging. This retrospective study was performed to review our high KDPI DD transplant results to identify clinical practices that can improve future outcomes. Methods We retrospectively calculated the KDPI for 895 DD kidney recipients transplanted between 1/2002 and 11/2013. Age, race, body mass index (BMI), retransplantation, gender, diabetes (DM), dialysis time, and preexisting coronary artery disease (CAD) (previous myocardial infarction (MI), coronary artery bypass (CABG), or stenting) were determined for all recipients. Results About 29.7% (266/895) of transplants were from donors with a KDPI ≥85%. By Cox regression older age, diabetes, female gender, and dialysis time >4 years correlated with shorter patient survival time. Diabetics with CAD who received a high KDPI donor kidney had a significantly increased risk of death (HR 4.33 (CI 1.82–10.30), P =.001) compared to low KDPI kidney recipients. The Kaplan‐Meier survival curve for diabetic recipients of high KDPI kidneys was significantly worse if they had preexisting CAD ( P <.001 by log‐rank test). Conclusion Patient survival using high KDPI donor kidneys may be improved by avoiding diabetic candidates with preexisting CAD.