Accepting High-Risk Kidneys Is Better Than Waiting

A high KDPI kidney offer can maximize the probability of graft function for young and old patients.
A high KDPI kidney offer can maximize the probability of graft function for young and old patients.
The following article is part of conference coverage from the 2017 American Transplant Congress (ATC) in Chicago, Illinois. Renal and Urology News' staff will be reporting breaking news associated with research conducted by leading experts in transplantation. Check back for the latest news from ATC 2017.

Even high-risk kidneys provide potential benefit to kidney transplant candidates compared with declining the offer and remaining on the kidney transplant wait list, researchers reported at the 2017 American Transplant Congress in Chicago.

Andrew Wey, PhD, of the Scientific Registry of Transplant Recipients in Minneapolis, and colleagues investigated the tradeoff between transplanting a high-KDPI [Kidney Donor Profile Index] kidney versus the risk of waiting for a better kidney. Dr Wey's team estimated the probability of a functioning kidney graft in 1 to 5 years from the time of offer of a deceased-donor kidney with a KDPI of 95% and an expected 30 hours of cold ischemia time.

Due to the low likelihood of a transplant, the researchers observed, accepting a high KDPI kidney offer can maximize the probability of graft function for young and old patients, the researchers reported. For example, a 35-year-old male transplant candidate who accepts the offer of a high KDPI kidney has a 76% probability of having a functioning graft 5 years post-offer. The probability of having a functioning graft at 5 years post-offer declines to 33% for the same patient who declines the offer and remains on the wait list for 3 years. For a 65-year-old male candidate, the probabilities are 70% and 20%, respectively.

Dr Wey and his colleagues noted that about 20% of recovered decease-donor kidneys and more than 50% of deceased-donor kidneys with a high donor risk (KDPI greater than 85%) are discarded. Less than 50% of patients on the wait list undergo a first deceased-donor transplant within 5 years.

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Reference

Wey A, Salkowski N, Kremers W, et al. Accepting a high-KDPI kidney versus waiting for another offer can improve changes of a functioning graft. [abstract]. Am J Transplant 2017;17 (suppl 3). Poster presented at the 2017 American Transplant Congress in Chicago, April 29–May 3. Abstract A102.


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