How do we determine the fate of the kidney transplant with high KDPI kidney?

Sung Hoon Kim; Hassan Aziz; Sarat Kuppachi

doi:10.1016/j.ajt.2024.12.070

Background: Despite high Kidney Donor Profile Index (KDPI) kidney having shorter graft survival and higher rates of early graft dysfunction or primary non- function compared to low KDPI kidneys, their use has increased based on factors such as biopsy findings and pump characteristics. This study aims to identify clinical and pathological factors that predict the outcomes of kidney transplants using high KDPI kidneys at a single center. Methods: A retrospective analysis was conducted on 53 patients who underwent kidney transplants with high KDPI kidneys (KDPI > 85) from January 2014 to December 2023. Patients were categorized based on estimated glomerular filtration rate (eGFR) one year post- transplant, into those < 30, or ? 30. Clinicalopathological parameters of patients were compared between the two groups to identify predictors of transplant outcomes. Results: Over a median follow-up period of 37 months, 10 out of 53 patients exhibited an eGFR of less than 30 at one year post-transplant. Recipient characteristics, such as calculated panel reactive antibody (cPRA), waiting time, delayed graft function, and rejection rates, did not significantly differ between groups. However, donor characteristics, including KDPI score (median 95 vs. 91; p = 0.002) and history of diabetes mellitus (DM) (77.8% vs. 23.3%; p = 0.003), were significantly associated with poorer outcomes. Receiver Operating Curve (ROC) analysis identified a KDPI cut-off value of 93 (AUC = 0.801, p < 0.001). Multivariable logistic regression indicated that donor DM history (OR = 45.696, p = 0.034) and KDPI > 93 (OR = 23.791, p = 0.039) were significant predictors of lower eGFR at one year. Conclusion: While the use of high KDPI kidneys has expanded to address the gap between organ supply and demand, outcomes vary widely. Our findings suggest that kidneys from donors with a KDPI greater than 93 and a history of DM may lead to poor transplant outcomes. Larger data base analyses would be required to better analyze these findings, so that risk factors can be carefully considered when accepting organ offers to optimize patient benefit and graft survival.

How do we determine the fate of the kidney transplant with high KDPI kidney?

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