The Benefits of Preemptive Transplantation Using High-Kidney Donor Profile Index Kidneys

• Published in: Clinical journal of the American Society of Nephrology 2023-05, Vol.18 (5), p.634-643
• Main Authors: Kadatz, Matthew J, Gill, Jagbir, Gill, Justin, Lan, James H, McMichael, Lachlan C, Chang, Doris T, Gill, John S
• Format: Article
• Language: English
• Subjects: Adult; Donor Selection; Female; Graft Rejection - prevention & control; Graft Survival; Humans; Kidney Transplantation - adverse effects; Male; Middle Aged; Original; Registries; Retrospective Studies; Time Factors; Tissue Donors; Transplantation; Treatment Outcome
• ISSN: 1555-9041; 1555-905X; 1555-905X
• DOI: 10.2215/CJN.0000000000000134

The Kidney Donor Profile Index (KDPI) is a percentile score summarizing the likelihood of allograft failure: A KDPI ≥85% is associated with shorter allograft survival, and 50% of these donated kidneys are not currently used for transplantation. Preemptive transplantation (transplantation without prior maintenance dialysis) is associated with longer allograft survival than transplantation after dialysis; however, it is unknown whether this benefit extends to high-KDPI transplants. The objective of this analysis was to determine whether the benefit of preemptive transplantation extends to recipients of transplants with a KDPI ≥85%. This retrospective cohort study compared the post-transplant outcomes of preemptive and nonpreemptive deceased donor kidney transplants using data from the Scientific Registry of Transplant Recipients. 120,091 patients who received their first, kidney-only transplant between January 1, 2005, and December 31, 2017, were studied, including 23,211 with KDPI ≥85%. Of this cohort, 12,331 patients received a transplant preemptively. Time-to-event models for the outcomes of allograft loss from any cause, death-censored graft loss, and death with a functioning transplant were performed. Compared with recipients of nonpreemptive transplants with a KDPI of 0%-20% as the reference group, the risk of allograft loss from any cause in recipients of a preemptive transplant with KDPI ≥85% (hazard ratio [HR], 1.51; 95% confidence interval [CI], 1.39 to 1.64) was lower than that in recipients of nonpreemptive transplant with a KDPI ≥85% (HR, 2.39; 95% CI, 2.21 to 2.58) and similar to that of recipients of a nonpreemptive transplant with a KDPI of 51%-84% (HR, 1.61; 95% CI, 1.52 to 1.70). Preemptive transplantation is associated with a lower risk of allograft failure, irrespective of KDPI, and preemptive transplants with KDPI ≥85% have comparable outcomes with nonpreemptive transplants with KDPI 51%-84%.