Kidney transplant outcomes according to matching of the Kidney Donor Profile Index and Estimated Post-Transplant Survival scores

Background The efficient allocation of donor kidneys to appropriate candidates is mandated in Korea, with a very long waiting time for deceased donor kidney transplantation (DDKT). This study evaluated the prognostic implications of organ matching using the Korean Kidney Donor Profile Index (K-KDPI) and Korean Estimated Post-Transplant Survival (K-EPTS). Methods We analyzed 7,443 DDKT recipients between 2008 and 2022 using national databases: the Korean Network for Organ Sharing and the National Health Insurance Data Sharing Service. Patients were classified into classes 1 (low K-KDPI [<70] to low K-EPTS [<20] score), 2 (low K-KDPI to high K-EPTS [≥20]), 3 (high K-KDPI [≥70] to low K-EPTS), and 4 (high K-KDPI to high K-EPTS). Patient and graft survival rates were compared among the groups. Results Compared with class 1, classes 2 and 4 demonstrated a higher risk of graft failure (hazard ratio [HR], 1.94 and 3.04 for classes 2 and 4, respectively). For patient survival, classes 2 (HR, 2.77) and 4 (HR, 4.29) exhibited an increased risk compared with class 1, whereas class 3 (HR, 1.32) did not show significant differences. We developed a predictive model for the survival benefits of DDKT over dialysis based on the K-KDPI and K-EPTS scoring systems. Conclusion To enhance efficient utilization, it is desirable to introduce longevity-matching that prioritizes the allocation of donor organs with low K-KDPI to recipients with low K-EPTS. A predictive model of the survival benefits of DDKT over dialysis could guide decisions regarding the acceptance of organ offers.