Should Older Patients Accept a High KDPI Kidney or Wait? A National Data Analysis of Matched Cohorts.

Abstract

This study addressed whether kidney transplant (KTx) candidates, ages 60+, should accept a high KDPI kidney and differences when considering a high (>85% vs low (<85%) KDPI KTx. To date, there is limited survival data to guide decision-making for patients aged 60 years and older who are faced with the choice of accepting a high KDPI kidney or remaining on the waitlist. Propensity-matched cohort study using data from United Network on Organ Sharing (2014-2021). Cox proportional hazard models and competing risk models allowed comparison of (1) patient survival on the waitlist or after KTx and (2) patient and graft survival after KTx for the second comparison between matched groups, stratified by age groups: 60-65, 66-70, and 71+. Receiving a >85% KDPI kidney versus remaining on the waitlist was associated with reduced mortality (HR 0.68, 95% CI 0.59-0.80, P<0.001) overall and across the two oldest age groups: 66-70 (HR 0.57, 95% CI 0.44-0.73, P<0.001) and 71+ (HR 0.59, 95% CI 0.44-0.83, P<0.001). Those aged 60-65 did not experience a survival benefit (HR 0.86, 95% CI 0.67-1.11, P=0.259). Patients ages 60+ receiving a >85% or ≤85% KDPI kidney experience comparable survival rates. Our study revealed a survival advantage linked to receiving a lower-quality KTx than remaining on the waitlist in the overall sample and for those 66+. Graft failure and survival were independent of the organ quality.