OBJECTIVES: To better serve patients on the kidney transplant waitlist in the US, current guidance recommends the expanded use of kidneys with higher Kidney Donor Profile Index (KDPI) score to offset the limited supply of standard criteria donor. This research aims to explore KDPI score and evaluate patient characteristics associated with higher KDPI Kidney Transplant (KT).

METHODS: A retrospective study was conducted using the United Network for Organ Sharing’s Organ Procurement and Transportation Network (UNOS OPTN) database. Individuals aged 18-99 years old, who received a KT between 2010 –2019 with a complete dataset were included in the study. We collected recipient characteristics and frequencies of KT based on KDPI score (<35, 35-85, >85). A logistic regression analysis was run to assess recipients’ variables associated with >85 KDPI score kidneys.

RESULTS: 106,448 KT recipients were included in the analysis. Of these, only 6.8% of KT included kidneys with >85 KDPI score. Trends of KT from 2010-2019 in >85 KDPI kidney utilization by age group remained largely unchanged. 23.8% of >85 KDPI KTs were performed on ≥70-year-old recipients, compared to 45.5% in 60–69-year-olds, 30.2% in 30–59-year-olds and 0.5% in <30-year-olds. When compared to those <30 years old, KT recipients aged 70+ years had 30-fold increased odds (OR 30.7, 95% CI: 22.14-42.54) of receiving a >85 KDPI kidney. Diabetics and Black or Hispanic were found to be more likely of receiving a >85 KDPI kidney, while women and patients with glomerulonephritis or congenital rare familial disease were found to be less likely to receive a >85 KDPI kidney.

CONCLUSIONS: Contrary to current recommendations, utilization of KDPI kidneys >85 remained modest during 2010-2019. Several recipient characteristics were found to affect utilization of higher KDPI KT. These findings can better inform decision makers on KT resource allocation based on KDPI score.