Published online Aug 9, 2018. doi: 10.5500/wjt.v8.i4.102
Peer-review started: April 11, 2018
First decision: May 3, 2018
Revised: May 21, 2018
Accepted: May 30, 2018
Article in press: May 31, 2018
Published online: August 9, 2018
Core tip: Increasing waiting-time for deceased donor kidney (DDK) transplantation adversely impacts older patients disproportionately. Dialysis vintage and transplantation of “marginal kidneys” are associated with inferior post-transplant outcomes. Using OPTN/United Network for Organ Sharing database from 2001-2015, we compared the outcomes of preemptive transplantation of marginal [kidney donor profile index (KDPI) ≥ 85%] DDKs compared to transplanting better quality DDKs (KDPI 35%-84%) after being on dialysis for 1-4 and 4-8 years in patient > 60 years old. Preemptive transplantation of marginal kidneys provided non-inferior graft and patient outcomes compared to transplanting better quality kidneys in older patients on maintenance dialysis. Early transplantation could also provide quality of life and cost benefits.