He Shengliang, Thomas Christie P, Gunderson Alan E, Ten Eyck Patrick, Reed Alan I
Division of Transplant and Hepatobiliary Surgery, Department of Surgery, Organ Transplant Center, University of Iowa Hospital and Clinics, Iowa City, IA.
Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA.
Transplant Direct. 2025 Jun 27;11(7):e1827. doi: 10.1097/TXD.0000000000001827. eCollection 2025 Jul.
A recent Organ Procurement and Transplant Network policy change removes hepatitis C virus (HCV) status and race from the Kidney Donor Profile Index (KDPI) calculation, thereby lowering the KDPI of HCV nucleic acid testing positive (NAT) kidneys and increasing their allocation priority. However, even in the era of direct-acting antivirals, high KDPI HCV NAT kidneys exhibited higher discard rates compared with their HCV NAT counterparts, and outcome data for this "high-risk" group remain limited. This study aims to address this knowledge gap by providing comprehensive outcome data to better inform organ allocation and selection decisions under the new KDPI framework.
Using national transplant data from 2015 to 2023, we analyzed adult deceased donor kidney transplants stratified by KDPI and HCV NAT status. An exact matching model was used to identify the matched HCV NAT group.
No significant differences were observed in delayed graft function, rejection, or patient and graft survival between high KDPI HCV NAT and matched HCV NAT recipients. High KDPI HCV NAT kidneys were more often allocated regionally or nationally, with 67.6% occurring in 4 regions. Their recipients were more likely to have a high school education and shorter wait times. After the policy change, >90% of prior high KDPI HCV NAT kidneys will no longer be classified as high KDPI.
Our findings support the safe utilization of previously high KDPI HCV NAT kidneys after a policy change. Although the revised KDPI may assist clinicians in identifying higher-quality organs, its impact on existing sociodemographic disparities and overall organ utilization rate remains uncertain.
器官获取与移植网络最近的一项政策变更，将丙型肝炎病毒（HCV）状态和种族从肾脏捐赠者特征指数（KDPI）计算中去除，从而降低了HCV核酸检测呈阳性（NAT）肾脏的KDPI，并提高了它们的分配优先级。然而，即使在直接作用抗病毒药物时代，高KDPI的HCV NAT肾脏与HCV NAT阴性的肾脏相比，其丢弃率仍更高，并且针对这个“高风险”群体的结局数据仍然有限。本研究旨在通过提供全面的结局数据来填补这一知识空白，以便在新的KDPI框架下更好地为器官分配和选择决策提供信息。
利用2015年至2023年的全国移植数据，我们分析了按KDPI和HCV NAT状态分层的成年 deceased 捐赠者肾脏移植情况。使用精确匹配模型来识别匹配的HCV NAT组。
高KDPI的HCV NAT受者与匹配的HCV NAT受者在移植肾功能延迟、排斥反应或患者及移植物存活方面未观察到显著差异。高KDPI的HCV NAT肾脏更多地在地区或全国范围内分配，67.6%发生在4个地区。其受者更有可能接受过高中教育且等待时间较短。政策变更后，超过90%之前高KDPI的HCV NAT肾脏将不再被归类为高KDPI。
我们的研究结果支持政策变更后安全使用之前高KDPI的HCV NAT肾脏。尽管修订后的KDPI可能有助于临床医生识别更高质量的器官，但其对现有的社会人口统计学差异和总体器官利用率的影响仍不确定。
