Preemptive kidney transplant in older adults linked to better patient, graft survival
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Key takeaways:
- Pre-transplant recipients were more often white and had fewer instances of diabetes.
- Survival improved for early and late kidney donor profile indexes greater than 85% pre-transplant.
PHILADELPHIA — Preemptive kidney transplant in older adults with a high kidney donor profile index pre-transplant may be linked to better patient and graft survival, data show.
“The perioperative risk and morbidity from immunosuppression are two concerns that are commonly cited that are balanced against the known benefits of preemptive, defined as prior-to-dialysis kidney transplant, and this causes some patients to be considered ‘too early’ for transplant,” Colleen Louise Jay, MD, of the Wake Forest University School of Medicine, said at the American Transplant Congress. “Accepting a high [kidney donor profile index] KDPI, or a KDPI greater than 85%, transplant can improve access to preemptive transplants for older patients. However, ... less than 20% of patients across age groups receive a preemptive transplant. The willingness to accept a high KDPI transplant has been declining and the non-utilization rate for these kidneys [is] above 60%.”
Researchers used United Network for Organ Sharing national data from 1994 to 2022 to study deceased donor KDPI greater than 85% kidney transplant alone in 15,854 patients aged 50 years. They evaluated patient survival and death-censored graft survival for early pre-transplant (defined as an eGFR between 15 mL/min/1.73 m2 and 20 mL/min/1.73 m2), late pre-transplant (eGFR less than 15 mL/min/1.73 m2) and non-pretransplant (on dialysis at transplant).
According to the findings, pre-transplant recipients were more often white, had fewer instances of diabetes and were less sensitized. Patient survival and death-censored graft survival improved for early and late KDPIs greater than 85% pre-transplant vs. to non-pretransplant. The latter outcome was equivalent for early vs. late pre-transplant in the first 4 years after transplant, according to the study.
“Given the superior survival we saw shown with preemptive transplant, we would argue robust effort should be made to perform preemptive transplant and that delaying transplant could result in patients missing their preemptive window,” Jay said.
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Jay C, et al. Poster 455. Presented at: American Transplant Congress; June 1-5, 2024; Philadelphia.
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