High KDPI Kidneys Still Underused

[Clark]

https://www.renalandurologynews.com/home/conference-highlights/american-transplant-congress/high-kdpi-kidneys-still-underused/

High KDPI Kidneys Still Underused
Natasha Persaud

Use of high Kidney Donor Profile Index (KDPI) kidneys with a score greater than 85 remained “modest” during 2010-2019, despite national efforts to increase it, investigators reported at the 2023 American Transplant Congress in San Diego, California.
Of 106,448 recipients of kidney transplants during 2010-2019 who were identified using the 2010-2019 United Network for Organ Sharing’s Organ Procurement and Transportation Network (UNOS-OPTN) database, only 6.8% received grafts with a KDPI score higher than 85, Ashesh P. Shah, MD, of Thomas Jefferson University in Philadelphia, Pennsylvania, reported on behalf of his team.
Age trends remained the same. Nearly a quarter (23.8%) of high KDPI transplantations were performed in recipients aged 70 years or older, 45.5% in those aged 60-69 years, 30.2% in those aged 30-59 years, and 0.5% in those younger than 30 years.
The likelihood of receiving a high KDPI kidney was a significant 30-fold higher for patients aged 70 years or older compared with those younger than 30 years. Patients with diabetes had significant 1.2-fold increased odds of accepting a high KDPI kidney. Black and Hispanic adults both had significant 1.3-fold increased odds of receiving a high KDPI kidney compared with White adults. Women and patients with glomerulonephritis or congenital rare familiar disease, however, had lower likelihood of receiving a high KDPI kidney.
“Pressures, such as outcomes reporting and perceived inadequate risk adjustment, disincentivize transplant programs from using high KDPI kidneys,” Dr Shah explained in an interview. “Older patients who have shorter expected post-transplant survival would probably be best served by receiving high KDPI allografts. These patients have the worst survival on the transplant list due to their age and comorbidities and would gain the most by being transplanted early.” According to the Organ Procurement & Transplantation Network, high KDPI kidneys last more than 5.5 years.
Dr Shah suggested conducting a national clinical trial to better understand high KDPI kidneys, identify optimal candidates, and standardize practice. Transplant programs and patients should opt in to participate in such a national clinical trial and be exempt from punitive national reporting, he noted.
“We need to clearly establish best practices for evaluation of these organs and patient care after transplantation,” Dr Shah added. “The field needs more information about these kidneys, in terms of pulsatile pump perfusion parameters, biopsy rapid permanent section histology and, perhaps, novel biomarkers. The KDPI score also probably needs to be updated, such as the hepatitis C penalty.”
References
1. Shah A, Litvintchouk A, Amaefule A, et al. 10 Year trends and patterns of kidney transplantation according to KDPI score and factors associated with allocation of higher KDPI score. Presented at: ATC 2023; June 3-7, San Diego, California. Abstract B143.
2. Kidney Donor Profile Index (KDPI) guide for clinicians. OPTN. Accessed on May 19, 2023.