title: Survival benefit of primary deceased donor transplantation with high-KDPI kidneys.
abstract: 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.
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD.
authors.forename: A B
authors.initials: AB
authors.lastname: Massie
authors.forename: X
authors.initials: X
authors.lastname: Luo
authors.forename: E K H
authors.initials: EK
authors.lastname: Chow
authors.forename: J L
authors.initials: JL
authors.lastname: Alejo
authors.forename: N M
authors.initials: NM
authors.lastname: Desai
authors.forename: D L
authors.initials: DL
authors.lastname: Segev
mesh_terms: D000328:Adult; D002102:Cadaver; D005260:Female; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D016019:Survival Analysis; D014019:Tissue Donors
keywords: Clinical decision-making; clinical research/practice; epidemiology; graft survival; kidney transplantation/nephrology; registry/registry analysis