Survival Benefit of Expanded Criteria Kidneys Probed

Expanded criteria donor kidneys do not confer a survival edge.
Expanded criteria donor kidneys do not confer a survival edge.

SAN FRANCISCO—Above a certain threshold of Kidney Donor Profile Index (KDPI), highly sensitized patients may not derive a survival benefit from expanded criteria donor (ECD) kidney transplantation, according to a new Canadian study presented at the 2014 World Transplant Congress.

The researchers looked at thousands of kidney transplant recipients and found that as waiting times and the characteristics of high KDPI donors are subject to change over time, frequent reevaluation of the survival benefit ECD transplantation in highly sensitized patients may be warranted.

John Gill, MD, from the University of British Columbia in Vancouver, and collaborators analyzed 1995–2007 data from the U.S. Renal Data System. They used multivariate non-proportional hazards analyses and determined the survival benefit of ECD transplantation among sensitized patients with PRA greater than 50% compared with the alternative strategy of continued waiting or transplantation with a standard criteria donor (SCD) transplant.

The median waiting time to transplantation was 2.8 years for 28,711 candidates (aged 18–49 years) and 2.2 years for 21,660 candidates (aged 50 years or older).

The researchers reported that transplantation with a KDPI greater than 0.80 was associated with a lower risk of death in candidates in both groups compared with the alternative strategy of waiting for an SCD kidney.

However, transplantation with a KDPI greater than 0.90 did not appear to be associated with a survival benefit in those aged 18–49 years. In addition, transplantation with a KDPI greater than 0.90 was associated with a decreased survival benefit related to allograft failures 5 years after transplantation in patients older than 50 years.

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