US deceased kidney transplantation: Estimated GFR, donor age and KDPI association with graft survival. (July 2021)

• Record Type: Journal Article
• Authors: Pruett, Timothy L.; Vece, Gabriel R.; Carrico, Robert J.; Klassen, David K.
• Is Part Of: EClinicalMedicine. Volume 37(2021)
• Publication Date: 2021-07
• Subjects: Transplantation -- Donation -- Age -- Outcomes -- Glomerular filtration rate (GFR); AUC area under curve -- CKD chronic kidney disease -- CKD-EPI Chronic Kidney Disease Epidemiology Collaboration Equation -- CI Confidence Interval -- CPRA calculated panel-reactive antibody -- DCD donation after circulatory death -- eGFR estimated glomerular filtration rate -- eGFR-1 one year after transplantation -- ESRD end stage renal disease -- HHS Department of Health and Human Services of the US government -- HRSA Health Resources and Services Administration, Agency within HHS -- KDIGO Kidney Disease Improving Global Outcomes -- KDPI kidney donor profile index -- KDRI kidney donor risk index -- OPTN Organ Procurement and Transplantation Network; Medicine -- Research -- Periodicals; Medical policy -- Periodicals; Clinical Medicine; Health Policy; Public Health; Medical policy; Medicine -- Research; Periodical; Electronic journals; Periodicals; 613
• DOI: 10.1016/j.eclinm.2021.100980
• Languages: English
• ISSNs: 2589-5370

Abstract

Abstract: Background: Despite a significant shortage of kidneys for transplantation in the US, kidneys from older deceased donors are infrequently transplanted. This is primarily over concern of graft quality and transplant durability. Methods: The US national transplant database (2000–2018) was assessed for deceased donor kidney transplant patient and graft survival, graft durability and stratified by donor age (<65 years>), Kidney Donor Profile Index (KDPI) and estimated glomerual filtration rate (GFR) one year post-transplantation (eGFR-1) were calculated. Findings: Recipients of kidneys transplanted from deceased donors >65 years had a lower eGFR-1, (median 39 ml/min) than recipients of younger donor kidneys (median 54 ml/min). However, death-censored graft survival, stratified by eGFR-1, demonstrated similar survival, irrespective of donor age or KDPI. The durability of kidney survival decreases as the achieved eGFR-1 declines. KDPI has a poor association with eGFR-1 and lesser for graft durability. While recipients of kidneys > 65 years had a higher one year mortality than younger kidney recipients, recipients of kidneys > 65 years and an eGFR-1 <30 ml/min, had a lower survival than an untransplanted waitlist cohort ( p <0.001). Interpretation: The durability of kidney graft survival after transplantation was associated with the amount of kidney function gained through the transplant (eGFR-1) and the rate of graft loss (return to dialysis) was not significantly associated with donor age. 24.9% of recipients of older donor kidneys failed to achieve sufficient eGFR-1 providing a transplant survival benefit. While there is significant benefit from transplanting older kidneys, better decision-making tools are required to avoid transplanting kidneys that provide insufficient renal function. Funding: None.