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Accepting High-Risk Kidneys Is Better Than Waiting

A high KDPI kidney offer can maximize the probability of graft function for young and old patients.
A high KDPI kidney offer can maximize the probability of graft function for young and old patients.
The following article is part of conference coverage from the 2017 American Transplant Congress (ATC) in Chicago, Illinois. Renal and Urology News' staff will be reporting breaking news associated with research conducted by leading experts in transplantation. Check back for the latest news from ATC 2017.

Even high-risk kidneys provide potential benefit to kidney transplant candidates compared with declining the offer and remaining on the kidney transplant wait list, researchers reported at the 2017 American Transplant Congress in Chicago.

Andrew Wey, PhD, of the Scientific Registry of Transplant Recipients in Minneapolis, and colleagues investigated the tradeoff between transplanting a high-KDPI [Kidney Donor Profile Index] kidney versus the risk of waiting for a better kidney. Dr Wey's team estimated the probability of a functioning kidney graft in 1 to 5 years from the time of offer of a deceased-donor kidney with a KDPI of 95% and an expected 30 hours of cold ischemia time.

Due to the low likelihood of a transplant, the researchers observed, accepting a high KDPI kidneyoffer can maximize the probability of graft function for young and old patients, the researchers reported. For example, a 35-year-old male transplant candidate who accepts the offer of a high KDPI kidney has a 76% probability of having a functioning graft 5 years post-offer. The probability of having a functioning graft at 5 years post-offer declines to 33% for the same patient who declines the offer and remains on the wait list for 3 years. For a 65-year-old male candidate, the probabilities are 70% and 20%, respectively.

Dr Wey and his colleagues noted that about 20% of recovered decease-donor kidneys and more than 50% of deceased-donor kidneys with a high donor risk (KDPI greater than 85%) are discarded. Less than 50% of patients on the wait list undergo a first deceased-donor transplant within 5 years.

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  • It's ironic that the higher your KDPI score the worse the kidney is! A KDPI of 82% means the risk of that kidney failing is 82% higher than other donor kidneys. So you want your donor to have a KDPI of ZERO! LOL
  • I accepted a high-risk kidney June 11, 2017 after 5 1/2 years on the waiting list and 3+ months on PD.  The transplant team would not tell me anything about the donor except that he/she had "no medical history", and for that reason is considered high risk.  I'm now about 2 months out and the doc tests for all the terrible stuff every month: HIV, HepC, Hep B, BK virus.  It's scary but I was so depressed doing PD 4 times a day.  I just pray that this kidney was meant for me and it's a keeper!!

    • Congratulations

    • I assume HIPA regulations preclude the Tx team from giving out information about the donor.  I was regularly followed by Infectious Disease for the first year after the Tx and do periodic special blood work for the Tx department.  In my case, the possibility of surviving another long wait on hemodialysis was very slim and this was best for me.  I do feel better than I did after my first, some fourteen years earlier.  I feel doubly blessed. 

  • Don't I know it!  The chances of me surviving a second bout with hemodialysis and a lengthy wait for a pristine 2nd kidney tx were very slim.  I jumped at the opportunity when one of these was offered to me.  So far, so good!

    • What made your kidney high risk kidneyboy? I assume the higher the number the worse the kidney?

      • The KDPI was never transmitted to me, nor the medical history....any KDPI above

        85% is @ risk.  I'm not perfect, why should my Tx kidney be?  The KDPI is only an estimate, who wants to live forever anyway?  So long as I don't get hit by a bus, leaving the hospital, I'm okay with my chances.  No one I know has ever received any guarantees in life. 

      • KDPI is a calculation based on several factors.  You can google it up.  But I would think the "high risk" of greatest concern is not knowing the medical history of donor.  For instance, was the donor a drug user and have a high risk of HIV?  

        If you're sick enough to die, it seems to me a risk is somehting you take.  

        I remember the Doc asking me if I wanted a transplant.  I said "Heck no! But if your convinced I need it to stay alive I guess I'll go for it".  

        Admit that I don't know much about all this.  Just commenting over a cup of coffee.

        • It is not like the Tx team screws it in and hopes for the best.  Extensive testing is done to be sure the donor is free of active known viruses and exposure markers before the organ is deemed viable and offered to a recipient.  Periodic tests performed by both ID and Tx doctors to check for any new developing markers.  I trusted my Tx center and jumped at the offer, I knew my time on dialysis was limited, one way or another.  So far it has been far superior than my first "pristine" donor Tx.

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