Goussous Naeem, De Leon Fransia, Alghannam Karima, Howard Brian C, Than Peter A, Wang Aileen X, Sageshima Junichiro, Perez Richard V
Division of Transplant Surgery, Department of Surgery, University of California Davis, Sacramento, CA.
Division of Transplant and Hepatobiliary Surgery, Department of Surgery, University of California San Diego, San Diego, CA.
Transplant Direct. 2024 Nov 15;10(12):e1738. doi: 10.1097/TXD.0000000000001738. eCollection 2024 Dec.
Kidney transplantation has been shown to improve life expectancy when compared with remaining on dialysis. However, there is an ever-expanding shortage of available organs for transplantation. The use of high kidney donor profile index (KDPI; >85) kidneys is 1 strategy to address this shortage. The current study aims to evaluate the advantage of accepting a high KDPI versus a low KDPI kidney (KDPI ≤85) in patients 65 y or older.
A single-center retrospective review of all patients, ages 65 y or older, who underwent deceased donor kidney transplantation between 2010 and 2020 was performed. Outcomes and wait times of recipients undergoing low KDPI (KDPI ≤85) versus high KDPI (KDPI >85) kidney transplantation were compared. Significance was defined as < 0.05.
Four hundred ninety-two patients were identified; 317 (64.4%) were men with a median age at transplantation of 69 y. Four hundred five patients received low KDPI kidneys, whereas the remaining received high KDPI grafts. High KDPI kidneys were procured from older donors (60 versus 47, < 0.001) and had shorter cold ischemic time (25.0 versus 28.3 h, = 0.01) compared with low KDPI kidneys. There was no significant difference in graft and patient survival between low and high KDPI recipients, with 85.1% and 86.2% grafts functioning at a follow-up of 4.85 (2.9-7.0) y, respectively. Pretransplant wait time was significantly shorter in the high KDPI group (2.7 [1.8-4.1] versus 3.5 [2.3-4.8] y; = 0.004).
In patients 65 y or older undergoing deceased donor kidney transplantation, high KDPI kidneys may offer shorter pretransplant waiting times without compromising graft or patient survival.
与继续接受透析相比，肾移植已被证明可提高预期寿命。然而，可供移植的器官短缺问题日益严重。使用高肾脏供体特征指数（KDPI；>85）的肾脏是解决这一短缺问题的一种策略。本研究旨在评估65岁及以上患者接受高KDPI肾脏与低KDPI肾脏（KDPI≤85）的优势。
对2010年至2020年间接受尸体供肾移植的所有65岁及以上患者进行单中心回顾性研究。比较接受低KDPI（KDPI≤85）与高KDPI（KDPI>85）肾移植受者的结局和等待时间。显著性定义为<0.05。
共确定492例患者；317例（64.4%）为男性，移植时的中位年龄为69岁。405例患者接受了低KDPI肾脏，其余患者接受了高KDPI移植物。与低KDPI肾脏相比，高KDPI肾脏取自年龄较大的供体（60岁对47岁，<0.001），冷缺血时间较短（25.0小时对28.3小时，=0.01）。低KDPI和高KDPI受者的移植物和患者生存率无显著差异，在4.85（2.9 - 7.0）年的随访中，分别有85.1%和86.2%的移植物功能良好。高KDPI组的移植前等待时间显著更短（2.7[1.8 - 4.1]年对3.5[2.3 - 4.8]年；=0.004）。
在65岁及以上接受尸体供肾移植的患者中，高KDPI肾脏可能提供更短的移植前等待时间，且不影响移植物或患者生存率。
