November 02, 2023

2 min read

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Key takeaways:

  • Patients with high vs. low kidney donor profile indexes had similar mortality rates.
  • Mortality and graft failure 1 year after transplant did not significantly differ between high- and low-index groups.

PHILADELPHIA — Kidneys from adults with a high kidney donor profile index may boost transplantation access, but a multidisciplinary method can bring positive results in groups with low deceased kidney donor transplant rates, a speaker said.

“We treat patients in a predominantly Black community in Brooklyn,” where there may be less access to required medical resources, Fausto Ricardo Cabezas, MD, of SUNY Downstate Health Sciences University in New York, told Healio of research he conducted with his team and that was presented at ASN Kidney Week.

kidney transplant
Patients with high vs. low kidney donor profile indexes had similar mortality rates. Image: Adobe Stock. 

The current kidney allocation system assigns kidneys from donors with higher indexes to recipients with a lower expected posttransplant survival score, he said. However, many high-index kidneys are discarded for fear of poor outcomes.

“We wanted to see if marginal kidneys can improve access to care in [this] population,” Cabezas said.

He and his colleagues analyzed data from the transplant quality improvement database of their institution for all adult primary deceased kidney donor transplants from 2022 to 2023, including 115 deceased kidney donor transplants. Of that cohort, 81.7% were Black patients and 46% were women.

Patients were categorized into two groups based on a high kidney donor profile index, above 80%, or a low index, less than 80%. Those with an index below 80% made up 70% of the group. Meanwhile, transplant recipients with a high index were older (66 years vs. 57 years), had longer ischemic times (26.6 hours vs. 23.8 hours) and higher expected posttransplant survival rates (64% vs. 68%) compared with the low-index group, according to the study.

Researchers compared 1-year mortality and allograft failure rates between the two groups.

Based on the findings, patients in the high-index group showed similar mortality rates and marginally lower delayed graft function, with no statistically significant disparities compared with low-index patients. Mortality and graft failure 1-year post-transplant did not significantly differ between the groups group, despite the older age of high-index recipients.

“Compared to the regular, standard-quality kidneys, high-risk kidneys did well in terms of mortality and allograft survival,” Cabezas said. “That’s potentially a way of ensuring that we’re using all the kidneys available for transplantation.”

Organs from donors with low indexes were more likely to be allocated to younger, highly sensitized adults, the researchers noted, adding that this aligns with standard protocol. In addition, while the low-index group faced a higher delayed graft function rate, likely due to accepting allografts from donors with AKI, the researchers advocate for high-index kidneys and a robust multiteam strategy early in the transplant period.

“We need to find more strategies to use all the kidneys available, and we need to find ways to make it equitable,” Cabezas said. “We know communities of color — Hispanics, Black communities — have less access to transplantation. This could be a great way of learning, and we’re showing that it’s safe at least [at] 1 year in our population.”


  • Cabezas FR, et al. PO883. Presented at: ASN Kidney Week; Nov. 2-5, 2023; Philadelphia.