Health Care Utilization in Elderly Deceased Donor Kidney Transplant Recipients

Background: High Kidney Donor Profile Index (KDPI) kidneys (KDPI >85%) are often associated with increased risks of post-kidney transplant (KT) complications and greater healthcare utilization (HCU), particularly in elderly recipients with multiple comorbidities. These concerns frequently lead to underutilization of high KDPI kidneys in older transplant candidates, thereby limiting their access to transplantation despite potential clinical benefits. This study aimed to compare post-KT HCU between elderly recipients of high versus low KDPI deceased donor kidneys. Primary outcome included differences in hospital readmissions, surgical interventions, and outpatient service use at multiple post-transplant time points. Secondary outcome included graft function, graft survival, and patient survival. Methods: A retrospective analysis of elderly solitary KT recipients (age >65 years) between January 1, 2011, and December 31, 2020. Patients were stratified into high KDPI (>85%, n=160) and low KDPI (<85%, n=453) groups. We assessed inpatient and outpatient HCU, including readmissions at 30-, 90-, and 365-days post-transplant, surgical interventions, and outpatient visits (emergency department, transplant clinic, endocrine clinic, and ambulatory infusion units). Results: There were no statistically significant differences between high and low KDPI groups in rates of hospital readmissions, surgical interventions, or outpatient visits (all p > 0.05). Delayed graft function rates were also similar (p = 0.61). The low KDPI group had significantly higher eGFR at 4 months, 1 year, 2 years, and 3 years post-transplant (all p < 0.001). However, days alive and out of the hospital within 90- and 365-days post-transplant were comparable between the groups (all p > 0.05). Overall patient survival was similar (p = 0.08), though death-censored graft loss was significantly higher in the high KDPI group (p = 0.001). Conclusions: Among elderly kidney transplant recipients, high KDPI kidney recipients had comparable post-transplant healthcare utilization and overall survival to those receiving low KDPI kidneys, despite lower long-term graft function. These findings suggest that high KDPI kidneys remain a viable option for older patients, offering timely access to transplantation.