title: Survival Benefit in Older Patients Associated With Earlier Transplant With High KDPI Kidneys.
abstract: BACKGROUND
  Given high dialysis mortality rates for patients older than 60 years, accepting a kidney with a high Kidney Donor Profile Index (KDPI) score could enable earlier and potentially preemptive transplantation (preKT). However, evidence regarding the risks of high KDPI allografts in older patients is limited. Our objective was to determine the relative benefit for older patients of KDPI greater than 85% transplant either preemptively or not compared with remaining on the waitlist.
  
  
  METHODS
  United Network of Organ Sharing data from 2003 to 2012 for adult deceased donor kidney transplant candidates was analyzed to evaluate patient survival in patients older than 60 years for preKT and non-preKT KDPI greater than 85% transplants compared with candidates remaining on the waitlist including patients who received KDPI 0% to 85% transplants according to multivariate Cox regression models.
  
  
  RESULTS
  In the first year posttransplant for KDPI greater than 85% of transplants in recipients older than 60 years, preKT had a reduced mortality hazard (hazards ratio [HR], 0.61; 95% confidence interval [95% CI], 0.41-0.90) and non-preKT an increased mortality hazard (HR, 1.15; 95% CI, 1.03-1.27) compared with the waitlist including KDPI 0% to 85% transplant recipients. At 1 to 2 years and after 2 years, both KDPI greater than 85% groups had significant reductions in mortality (1-2 years: preKT HR, 0.38; 95% CI, [0.23-0.60] and non-preKT HR, 0.52; 95% CI, 0.45-0.61; and 2+ years: preKT HR, 0.50; 95% CI, 0.38-0.66 and non-preKT HR, 0.64; 95% CI, 0.58-0.70, respectively).
  
  
  CONCLUSIONS
  PreKT and non-preKT KDPI greater than 85% transplant was associated with lower mortality hazard after the first year compared with the waitlist including KDPI 0% to 85% transplants in patients older than 60 years. Further consideration should be given to increased utilization of high KDPI grafts in older patients with the goal of avoiding or limiting time on dialysis.
authors: 1 Transplant Center, University of Texas Health Science Center, San Antonio, TX. 2 Division of Transplant Surgery, Mayo Clinic, Rochester, MN. 3 Methodist University Hospital Transplant Institute, University of Tennessee Health Science Center, Memphis, TN. 4 South Texas Veterans Health Care System, San Antonio, TX. 5 Division of Hospital Medicine, University of Texas Health Science Center, San Antonio, TX.
authors: Colleen L
authors: CL
authors: Jay
authors: Kenneth
authors: K
authors: Washburn
authors: Patrick G
authors: PG
authors: Dean
authors: Ryan A
authors: RA
authors: Helmick
authors: Jacqueline A
authors: JA
authors: Pugh
authors: Mark D
authors: MD
authors: Stegall
mesh_terms: D000367:Age Factors; D000368:Aged; D016009:Chi-Square Distribution; D046148:Donor Selection; D005260:Female; D006085:Graft Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000209:etiology; D016016:Proportional Hazards Models; D012042:Registries; D006435:Renal Dialysis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D061665:Time-to-Treatment; D014019:Tissue Donors / Q000600:supply & distribution*; D016896:Treatment Outcome; D014481:United States; D014850:Waiting Lists / Q000401:mortality