Functional status-based risk–benefit analyses of high-KDPI kidney transplant versus dialysis

Kevin Bui, Vikram Kilambi, Sanjay Mehrotra*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

22 Scopus citations


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 languageEnglish (US)
Pages (from-to)1297-1312
Number of pages16
JournalTransplant International
Issue number12
StatePublished - Dec 1 2019


  • functional status
  • other
  • outcome
  • risk-Benefit
  • selection criteria
  • survival

ASJC Scopus subject areas

  • Transplantation


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