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Should Older Patients Accept a High Kidney Donor Profile Index Kidney or Wait? A National Data Analysis of Matched
Tambi Jarmi1, Rose Mary Attieh1, Emily Brennan2
1Department of Transplant, Mayo Clinic Florida, Jacksonville, Florida, USA.
Objective:
To address whether kidney transplant (KTx) candidates, ages 60+, should accept a high Kidney Donor Profile Index (KDPI) kidney and differences when considering a high (>85%) versus low (<85%) KDPI KTx.
Background:
To date, there is limited survival data to guide decision-making for patients aged ≥60 years who are faced with the choice of accepting a high KDPI kidney or remaining on the waitlist.
Methods:
Propensity-matched cohort study using data from United Network on Organ Sharing (2014-2021). Cox proportional hazard models and competing risk models allowed comparison of (1) patient survival on the waitlist or after KTx and (2) patient and graft survival after KTx for the second comparison between matched groups, stratified by age groups: 60 to 65, 66 to 70, and 71+.
Results:
Receiving a >85% KDPI kidney versus remaining on the waitlist was associated with reduced mortality [Hazard Ratio (HR): 0.68, 95% CI: 0.59-0.80, P < 0.001] overall and across the 2 oldest age groups: 66 to 70 (HR: 0.57, 95% CI: 0.44-0.73, P < 0.001) and 71+ (HR: 0.59, 95% CI: 0.44-0.83, P < 0.001). Those aged 60 to 65 did not experience a survival benefit (HR: 0.86, 95% CI: 0.67-1.11, P = 0.259). Patients ages 60+ receiving a >85% or ≤85% KDPI kidney experience comparable survival rates.
Conclusions:
Our study revealed a survival advantage linked to receiving a lower-quality KTx than remaining on the waitlist in the overall sample and for those 66+. Graft failure and survival were independent of the organ quality.
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