Safiee Siavash, Moein Mahmoudreza, Sia Isabel, Passafiume Danielle, Kim Lorie, Golkarieh Alireza, Saidi Reza
Tehran Medical Branch, Islamic Azad University, Tehran, Iran.
Division of Transplant Services, Department of Surgery, SUNY Upstate Medical University, 750 East Adams Street, Syracuse, NY, 13210, USA.
Int Urol Nephrol. 2025 Aug 16. doi: 10.1007/s11255-025-04733-6.
Utilizing kidneys with a Kidney Donor Profile Index (KDPI) score above 85 could be beneficial, especially in End-Stage Kidney Disease (ESKD) patients older than 65. Our study aimed to assess the outcomes of preemptive kidney transplants (KT) in these patients over 65 receiving high KDPI kidneys (≥ 85) and compare the outcomes to the non-preemptive kidney recipients.
This retrospective cohort analyzed the SRTR database for KTs that were performed in the United States from January 2000 to May 2023. This study includes patients older than 65 years old who received only deceased donor KTs, excluding those waitlisted or with prior organ transplants and missing in KDPI scoring. Participants were categorized into four groups: high KDPI preemptive, low KDPI preemptive, high KDPI non-preemptive, and low KDPI non-preemptive. Time-to-event models were used to assess death censored graft loss, and death, adjusting for recipients and donors variables.
A total of 47,077 patients aged 65 years and older were included. The median age of the study population was 69 (interquartile rang: 66 - 72) years old and the median follow-up time was 3.1 years. In multivariable Cox regression model, high KDPI non-preemptive transplantation was associated with the worst survival for death censored allograft failure compared to the low KDPI preemptive group, in the presence of confounding variables (HR: 2.89 95% CI: 2.58-3.24). This was followed by the high KDPI preemptive group (HR: 1.88, 95% CI: 1.54-2.30) and low KDPI non-preemptive group (HR: 1.52, 95% CI: 1.37-1.68). Similarly, the high KDPI non-preemptive group had the worst patients' survival outcomes (HR: 1.80, 95% CI: 1.61-2.02), followed by the low KDPI non-preemptive (HR: 1.47, 95% CI: 1.33-1.63), and the high KDPI preemptive group (HR: 1.28, 95% CI: 1.05-1.57).
Older patients can benefit from KT, even when receiving a high-KDPI kidney. Long-term patient survival in older individuals who received high-KDPI kidneys is comparable to low-KDPI recipients. Additionally, preemptive KT led to better outcomes, even in high KDPI cases, underscoring the importance of transplant timing.
利用肾脏捐赠者特征指数（KDPI）评分高于85的肾脏可能有益，特别是对于65岁以上的终末期肾病（ESKD）患者。我们的研究旨在评估65岁以上接受高KDPI肾脏（≥85）的患者进行先发制肾移植（KT）的结果，并将结果与非先发制肾移植受者进行比较。
这项回顾性队列研究分析了2000年1月至2023年5月在美国进行的KT的SRTR数据库。本研究包括65岁以上仅接受尸体供肾KT的患者，不包括那些列入候补名单或有过器官移植以及KDPI评分缺失的患者。参与者被分为四组：高KDPI先发制、低KDPI先发制、高KDPI非先发制和低KDPI非先发制。使用事件发生时间模型评估死亡截尾的移植物丢失和死亡情况，并对受者和供者变量进行调整。
共纳入47077名65岁及以上的患者。研究人群的中位年龄为69岁（四分位间距：66 - 72岁），中位随访时间为3.1年。在多变量Cox回归模型中，与低KDPI先发制组相比，在存在混杂变量的情况下，高KDPI非先发制移植与死亡截尾的同种异体移植物失败的最差生存率相关（HR：2.89，95%CI：2.58 - 3.24）。其次是高KDPI先发制组（HR：1.88，95%CI：1.54 - 2.30）和低KDPI非先发制组（HR：1.52，95%CI：1.37 - 1.68）。同样，高KDPI非先发制组的患者生存结果最差（HR：1.80，95%CI：1.61 - 2.02），其次是低KDPI非先发制组（HR：1.47，95%CI：1.33 - 1.63），以及高KDPI先发制组（HR：1.28，95%CI：1.05 - 1.57）。
老年患者即使接受高KDPI的肾脏也能从肾移植中获益。接受高KDPI肾脏的老年个体的长期患者生存率与低KDPI受者相当。此外，先发制肾移植即使在高KDPI病例中也能带来更好的结果，突出了移植时机的重要性。
