Abstract
Yearly, over half of deceased-donor kidneys with kidney donor profile index (KDPI) > 85 were discarded, yet they could improve survival outcomes for dialysis patients. The potential risk of high-KDPI kidney transplant (KT) depends on the patient's overall health summarized by functional status, which should be examined. The analyzed cohort consisted of adult deceased-donor KT candidates on dialysis listed in 2005–2014. A multivariate Cox proportional hazards model was fitted with functional status, measured using Karnofsky Performance Score (KPS), and transplant status as time-varying covariates. Derived from the Cox model, survival curves were analyzed to compare the survival outcomes between dialysis and transplant with different kidney qualities across three different KPS strata: 10–40, 50–70, and 80–100. With KDPI 0–99 KT, KPS 10–40 patients will survive ≥4.38 years median compared with 3.21 years median if they remained on dialysis. For KPS 50+ patients, the median survival years increase from 5.82 to 6.60 years on dialysis to ≥7.83 years after KDPI < 100 KT. The risk-adjusted analyses suggested that patients are expected to benefit more from KDPI 81–99 KT than from remaining on dialysis.
| Original language | English (US) |
|---|---|
| Journal | Transplant International |
| DOIs | |
| State | Published - Jan 1 2019 |
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Keywords
- functional status
- other
- outcome
- risk-Benefit
- selection criteria
- survival
ASJC Scopus subject areas
- Transplantation
Cite this
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Functional status-based risk–benefit analyses of high-KDPI kidney transplant versus dialysis. / Bui, Kevin; Kilambi, Vikram; Mehrotra, Sanjay.
In: Transplant International, 01.01.2019.Research output: Contribution to journal › Article
TY - JOUR
T1 - Functional status-based risk–benefit analyses of high-KDPI kidney transplant versus dialysis
AU - Bui, Kevin
AU - Kilambi, Vikram
AU - Mehrotra, Sanjay
PY - 2019/1/1
Y1 - 2019/1/1
N2 - Yearly, over half of deceased-donor kidneys with kidney donor profile index (KDPI) > 85 were discarded, yet they could improve survival outcomes for dialysis patients. The potential risk of high-KDPI kidney transplant (KT) depends on the patient's overall health summarized by functional status, which should be examined. The analyzed cohort consisted of adult deceased-donor KT candidates on dialysis listed in 2005–2014. A multivariate Cox proportional hazards model was fitted with functional status, measured using Karnofsky Performance Score (KPS), and transplant status as time-varying covariates. Derived from the Cox model, survival curves were analyzed to compare the survival outcomes between dialysis and transplant with different kidney qualities across three different KPS strata: 10–40, 50–70, and 80–100. With KDPI 0–99 KT, KPS 10–40 patients will survive ≥4.38 years median compared with 3.21 years median if they remained on dialysis. For KPS 50+ patients, the median survival years increase from 5.82 to 6.60 years on dialysis to ≥7.83 years after KDPI < 100 KT. The risk-adjusted analyses suggested that patients are expected to benefit more from KDPI 81–99 KT than from remaining on dialysis.
AB - Yearly, over half of deceased-donor kidneys with kidney donor profile index (KDPI) > 85 were discarded, yet they could improve survival outcomes for dialysis patients. The potential risk of high-KDPI kidney transplant (KT) depends on the patient's overall health summarized by functional status, which should be examined. The analyzed cohort consisted of adult deceased-donor KT candidates on dialysis listed in 2005–2014. A multivariate Cox proportional hazards model was fitted with functional status, measured using Karnofsky Performance Score (KPS), and transplant status as time-varying covariates. Derived from the Cox model, survival curves were analyzed to compare the survival outcomes between dialysis and transplant with different kidney qualities across three different KPS strata: 10–40, 50–70, and 80–100. With KDPI 0–99 KT, KPS 10–40 patients will survive ≥4.38 years median compared with 3.21 years median if they remained on dialysis. For KPS 50+ patients, the median survival years increase from 5.82 to 6.60 years on dialysis to ≥7.83 years after KDPI < 100 KT. The risk-adjusted analyses suggested that patients are expected to benefit more from KDPI 81–99 KT than from remaining on dialysis.
KW - functional status
KW - other
KW - outcome
KW - risk-Benefit
KW - selection criteria
KW - survival
UR - http://www.scopus.com/inward/record.url?scp=85070079421&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85070079421&partnerID=8YFLogxK
U2 - 10.1111/tri.13483
DO - 10.1111/tri.13483
M3 - Article
C2 - 31323698
AN - SCOPUS:85070079421
JO - Transplant International
JF - Transplant International
SN - 0934-0874
ER -