for high-KDPI kidneys was associated with 15% higher adjusted rates of deceased donor transplantation. Background Despite known benefits of kidney transplantation, including transplantation from donors with increased risk factors, many waitlisted candidates die before transplantation. Consent to receive donor kidneys with lower expected survival (e.g., Kidney Donor Profile Index [KDPI] >85%) is typically obtained at waitlist placement. The presumed benefit of consent to receive high-KDPI donor kidneys is higher likelihood and timeliness of donor offers for transplantation. However, the specific effect of consent on access to transplantation is unclear. Our aims were to evaluate the characteristics of candidates consenting to high-KDPI donor kidneys and the likelihood of receiving a deceased donor transplant over time on the basis of consent. Methods We used national Scientific Registry of Transplant Recipients data between 2015 and 2022 (n=213,364). We evaluated the likelihood of consent using multivariable logistic models and time to deceased donor transplant with cumulative incidence plots accounting for competing risks and multivariable Cox models. Results Overall, high-KDPI consent was 41%, which was higher among candidates who were older, were Black or Hispanic, had higher body mass index, had diabetes, had vascular disease, and had 12–48 months prelisting dialysis time, with significant center-level variation. High-KDPI consent was associated with higher rates of deceased donor transplant (adjusted hazard ratio=1.15; 95% confidence interval, 1.13 to 1.17) with no difference in likelihood of deceased donor transplant from donors with KDPI <85%. The effect of high-KDPI consent on higher rates of deceased donor transplantation was higher among candidates older than 60 years and candidates with diabetes and variable on the basis of center characteristics. Conclusions There is significant variation of consent for high-KDPI donor kidneys and higher likelihood of transplantation associated with consent....

中文翻译：

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量化美国高肾脏捐赠者概况指数已故捐赠者移植同意的影响

对于高 KDPI 肾脏，死亡供体移植的调整率提高了 15%。背景 尽管肾移植的好处众所周知，包括来自风险因素增加的捐赠者的移植，但许多候补候选人在移植前死亡。通常在候补名单中获得接受预期存活率较低（例如，肾脏捐赠者概况指数 [KDPI] > 85%）的捐赠肾脏的同意。同意接受高 KDPI 捐献肾脏的假定好处是捐献者提供移植的可能性和及时性更高。然而，同意对移植的具体影响尚不清楚。我们的目的是评估同意高 KDPI 供体肾脏的候选人的特征，以及在同意的基础上随着时间的推移接受已故供体移植的可能性。方法 我们使用 2015 年至 2022 年国家移植受者科学登记数据 (n=213,364)。我们使用多变量逻辑模型评估了同意的可能性，并通过考虑竞争风险和多变量 Cox 模型的累积发生率图来评估已故供体移植的时间。结果 总体而言，高 KDPI 同意率为 41%，在年龄较大、黑人或西班牙裔、体重指数较高、患有糖尿病、患有血管疾病、上市前透析时间为 12-48 个月的候选人中这一比例较高，显着中心级变异。高 KDPI 同意与较高的已故供体移植率相关（调整后的风险比 = 1.15；95% 置信区间，1.13 至 1.17），而 KDPI <85% 的供体进行已故供体移植的可能性没有差异。在 60 岁以上的候选人和患有糖尿病的候选人中，高 KDPI 同意对较高的已故供体移植率的影响更大，并且根据中心特征而变化。结论 对于高 KDPI 供肾的同意存在显着差异，并且与同意相关的移植可能性更高......