Improved Utilization of Kidney allografts from Deceased Donor with High Kidney Donor Profile Index in Select Candidates
Nahel Elias, *Linda Irwin, *Stephanie Yagos, *Jay Fishman, *Eliot Heher
Massachusetts General Hospital, Boston, MA
Objective(s): Increase consent to, and transplantation of high Kidney Donor Profile Index (KDPI>85%) allografts, and assess outcomes. Design: Interventional, before-after trial. 2014 deceased donor kidney transplant (DDKT) allocation considered KDPI, a comparative percentile signifying donor factors affecting allograft function. KDPI>85% kidneys provide 5.6 years average function but are available earlier, and informed consent is mandatory to receive them. Setting: Tertiary referral hospital/transplant center. Patients: Waitlist candidate selection: age>65, Estimated Post-Transplant Survival (EPTS) in the lowest quintile, or significant co-morbidities. 236 candidates without KDPI>85% consent fit our criteria; 193 by age, 124 by EPTS>80%. 75 consented following intervention. Interventions: (1) Revised “KDPI>85% education/consent”, (2) Assessed KDPI>85% informed consent and transplant rate, and (3) Patients re-education. Main Outcome Measure(s): UNOS benchmark report KDPI>85% consent and transplant rate, and KDPI>85% allografts transplanted and their outcomes. Results: Comparing January 2017 and 2018 UNOS benchmark reports; KDPI>85% consent and transplant rate increased >2.5 times (Table). We transplanted 27 KDPI>85% kidneys (1/1/15-12/31/17). Two grafts failed. 52% had delayed graft function, 1-year graft survival for 2015-2016 was 86%, and 2-year graft survival for 2015 of 86%. Median KDPI was 91% and median 1-year creatinine was 1.33 mg/dL (2015) and 1.38 mg/dL (2016). Conclusion: KDPI>85% utilization, although risks shorter longevity, is appropriate for select candidates awaiting transplantation. An educational quality initiative doubled the consent and transplantation rate of these organs with excellent graft survival. Selecting donor and recipient combinations, maximizes the utilization benefit of these kidneys for specific candidates. Further analysis is needed to assess long term function.
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