New evidence reveals pre-emptive kidney transplants (that take place before a patient needs dialysis) can have a high success rate even with lower quality kidneys. The results, published in the Clinical Journal of the American Society of Nephrology, also suggest this may be a way to increase the number of organs available for transplant.
The Kidney Donor Profile Index (KDPI) is a percentile score summarizing the long-term likelihood of successful transplant. If the KDPI score is above a threshold of 85%, the kidney will often function for a shorter time or is often not used at all.
On the other hand, it’s well known that kidney patients who receive a transplant before they require dialysis tend to have better transplant outcomes (e.g., longer organ survival); however, it was unknown whether these pre-emptive benefits extend to high-KDPI transplants.
To investigate, Dr. Matthew Kadatz, a clinical assistant professor at the University of British Columbia’s Division of Nephrology, and his colleagues analyzed data of more than 120,000 people who received a kidney transplant in the United States between 2005 and 2017.
Their analysis reveals pre-emptive transplantation is associated with a lower risk of the kidney failing even if the KDPI was over 85%. Pre-emptive transplants with lower quality organs (with a KDPI above 85%) had similar outcomes to people on dialysis who received a kidney of better quality (with a KDPI of 51%–84%).
“This analysis might help us use more marginal kidneys with successful results,” says Kadatz. “This is good news for patients waiting for a transplant as we still don’t have enough organs to give everyone a transplant who needs one.”
While Kadatz and his team are encouraged by these findings, he notes a lot of work still needs to be done to figure out how to implement this safely and fairly for patients waiting for a transplant.