Survival Benefit in Older Patients Associated with Earlier Transplant with High KDPI Kidneys

Colleen L. Jay, Kenneth Washburn, Patrick G. Dean, Ryan A. Helmick, Jacqueline A. Pugh, Mark D Stegall

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

BACKGROUND: Given high dialysis mortality rates for patients >60 years old, 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>85% transplant either preemptively or not compared with remaining on the waitlist. METHODS: UNOS data from 2003-2012 for adult deceased donor kidney transplant candidates was analyzed to evaluate patient survival in patients >60 years old for preKT and non-preKT KDPI>85% transplants compared to candidates remaining on the waitlist including patients who received KDPI 0-85% transplants according to multivariate Cox regression models. RESULTS: In the first year posttransplant for KDPI>85% recipients >60 years old, preKT had a reduced mortality hazard (HR=0.61, 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 0-85% transplant recipients. At 1-2 years and after 2 years, both KDPI >85% groups had significant reductions in mortality (1-2 yrs: preKT HR= 0.38, 95%CI=0.23-0.60 and non-preKT HR= 0.52, 95%CI=0.45-0.61; and 2+ yrs: 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>85% transplant was associated with lower mortality hazard after the first year compared with the waitlist including KDPI 0-85% transplants in patients >60 years old. 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.

Original languageEnglish (US)
JournalTransplantation
DOIs
StateAccepted/In press - Aug 4 2016

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Tissue Donors
Transplants
Kidney
Survival
Mortality
Dialysis
Proportional Hazards Models
Allografts
Transplantation

ASJC Scopus subject areas

  • Transplantation

Cite this

Survival Benefit in Older Patients Associated with Earlier Transplant with High KDPI Kidneys. / Jay, Colleen L.; Washburn, Kenneth; Dean, Patrick G.; Helmick, Ryan A.; Pugh, Jacqueline A.; Stegall, Mark D.

In: Transplantation, 04.08.2016.

Research output: Contribution to journalArticle

Jay, Colleen L. ; Washburn, Kenneth ; Dean, Patrick G. ; Helmick, Ryan A. ; Pugh, Jacqueline A. ; Stegall, Mark D. / Survival Benefit in Older Patients Associated with Earlier Transplant with High KDPI Kidneys. In: Transplantation. 2016.
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title = "Survival Benefit in Older Patients Associated with Earlier Transplant with High KDPI Kidneys",
abstract = "BACKGROUND: Given high dialysis mortality rates for patients >60 years old, 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>85{\%} transplant either preemptively or not compared with remaining on the waitlist. METHODS: UNOS data from 2003-2012 for adult deceased donor kidney transplant candidates was analyzed to evaluate patient survival in patients >60 years old for preKT and non-preKT KDPI>85{\%} transplants compared to candidates remaining on the waitlist including patients who received KDPI 0-85{\%} transplants according to multivariate Cox regression models. RESULTS: In the first year posttransplant for KDPI>85{\%} recipients >60 years old, preKT had a reduced mortality hazard (HR=0.61, 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 0-85{\%} transplant recipients. At 1-2 years and after 2 years, both KDPI >85{\%} groups had significant reductions in mortality (1-2 yrs: preKT HR= 0.38, 95{\%}CI=0.23-0.60 and non-preKT HR= 0.52, 95{\%}CI=0.45-0.61; and 2+ yrs: 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>85{\%} transplant was associated with lower mortality hazard after the first year compared with the waitlist including KDPI 0-85{\%} transplants in patients >60 years old. 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.",
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T1 - Survival Benefit in Older Patients Associated with Earlier Transplant with High KDPI Kidneys

AU - Jay, Colleen L.

AU - Washburn, Kenneth

AU - Dean, Patrick G.

AU - Helmick, Ryan A.

AU - Pugh, Jacqueline A.

AU - Stegall, Mark D

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N2 - BACKGROUND: Given high dialysis mortality rates for patients >60 years old, 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>85% transplant either preemptively or not compared with remaining on the waitlist. METHODS: UNOS data from 2003-2012 for adult deceased donor kidney transplant candidates was analyzed to evaluate patient survival in patients >60 years old for preKT and non-preKT KDPI>85% transplants compared to candidates remaining on the waitlist including patients who received KDPI 0-85% transplants according to multivariate Cox regression models. RESULTS: In the first year posttransplant for KDPI>85% recipients >60 years old, preKT had a reduced mortality hazard (HR=0.61, 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 0-85% transplant recipients. At 1-2 years and after 2 years, both KDPI >85% groups had significant reductions in mortality (1-2 yrs: preKT HR= 0.38, 95%CI=0.23-0.60 and non-preKT HR= 0.52, 95%CI=0.45-0.61; and 2+ yrs: 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>85% transplant was associated with lower mortality hazard after the first year compared with the waitlist including KDPI 0-85% transplants in patients >60 years old. 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.

AB - BACKGROUND: Given high dialysis mortality rates for patients >60 years old, 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>85% transplant either preemptively or not compared with remaining on the waitlist. METHODS: UNOS data from 2003-2012 for adult deceased donor kidney transplant candidates was analyzed to evaluate patient survival in patients >60 years old for preKT and non-preKT KDPI>85% transplants compared to candidates remaining on the waitlist including patients who received KDPI 0-85% transplants according to multivariate Cox regression models. RESULTS: In the first year posttransplant for KDPI>85% recipients >60 years old, preKT had a reduced mortality hazard (HR=0.61, 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 0-85% transplant recipients. At 1-2 years and after 2 years, both KDPI >85% groups had significant reductions in mortality (1-2 yrs: preKT HR= 0.38, 95%CI=0.23-0.60 and non-preKT HR= 0.52, 95%CI=0.45-0.61; and 2+ yrs: 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>85% transplant was associated with lower mortality hazard after the first year compared with the waitlist including KDPI 0-85% transplants in patients >60 years old. 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.

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