OBJECTIVES: Several studies have shown that kidney transplantations with higher kidney donor profile index (KDPI) scores reduced mortality rates compared with remaining on dialysis or the waitlist hoping to receive a lower KDPI kidney. This study described the rate of 5-year graft failure of higher KDPI kidney transplants between sex and across different age groups.

METHODS: Recipients of ≥85 KDPI kidneys from 01/01/2010 to 06/30/2019 were identified using The United Network for Organ Sharing’s Organ Procurement and Transplantation Network (UNOS OPTN). Graft failure was defined as death, returning to dialysis, or kidney re-transplantation. Absolute and relative frequencies were used to describe the rate of 5-year graft failure in the population of ≥85 KDPI kidneys.

RESULTS: Of the 106,416 kidney transplants, 7,288 (6.8%) cases utilized ≥85 KDPI kidneys. Of these, 4,629 (63.5%) occurred in males. Thirty-eight (0.5%), 2,198 (30.2%), 3,317 (45.5%), and 1,735 (23.8%) transplantation cases occurred in patients < 30, 40-59, 60-69, and ≥70 years old, respectively. Overall, the 5-year graft failure occurred in 1,171 (16.1%) patients. The rate of 5-year graft failure occurred in 14.3% of transplantation cases in females and 17.1% in males. The rate of 5-year graft failure in patients < 30, 30-59, 60-69, and ≥70 years old were 28.9%, 19.9%, 14.4%, and 14.1%, respectively. The rates of 5-year graft failure were 22.3% during 2010-2012, 17.9% during 2013-2015, and 10.1% during 2016-2019.

CONCLUSIONS: The study shows significant differences in the rates of 5-year graft failure of higher KDPI kidney recipients based on sex and age groups. Notably, the 5-year graft failure was much greater in younger age groups. Importantly, the 5-year graft failure of higher KDPI kidneys improved over ten years. This information could be helpful to decision makers on KT resource allocation based on KDPI scores.