Decision Regret Profile and Long-Term Weight Evolution after Laparoscopic Sleeve Gastrectomy in Preparation for Kidney Transplantation

INTRODUCTION:Accepting a kidney donor profi le index (KDPI) >85% kidney may improve access to preemptive (prior to dialysis) kidney transplant (preKT) in older patients.Less than 20% of patients receive preKT.We examined the benefi t of early versus late KDPI>85% preKT according to residual native estimated glomerular fi ltration rate (eGFR).METHODS: Using UNOS data from 1994-2022 for KDPI>85% KT in patients 50 yrs (n=15,854), we evaluated patient survival (PS) and death-censored graft survival (DCGS) for early preKT (eGFR 15-20), late preKT (eGFR<15), and non-preKT (on dialysis at transplant).For preKT, eGFR was calculated according to non-race adjusted CKD-EPI.RESULTS: PreKT recipients were more often white, had less DM, and were less sensitized (white: 78% for early, 70% for late, and 49% for non-preKT, p<0.001;DM: 26% for early, 23% for late, 32% for non-preKT, p<0.001; cPRA>80%: 7% for early, 8% for late, 13% for non-preKT, p<0.001).PS and DCGS were improved for both early and late KDPI>85% preKT compared to non-preKT (Figure 1, log rank: p<0.001 for both).DCGS was equivalent for early vs late preKT in the fi rst 4 yrs post transplant (Figure 1B).For patients 50 years, 1 and 3-year PS were 96% and 84% for early preKT, 93% and 83% for late preKT, and 90% and 78% for non-preKT, respectively.Kidney DCGS at 1 and 3-yrs were 95% and 90% for early preKT, 95% and 91% for late preKT, and 90% and 83% for non-preKT.Survival comparisons were equivalent when limited to patients 60 and 65 yrs.CONCLUSIONS: Both early and late KDPI>85% preKT are associated with signifi cantly improved patient and graft survival compared with non-preKT.Early preKT was non-inferior to late preKT and exhibited increased DCGS after 4 yrs suggesting a role for enhanced utilization of KDPI>85% kidney transplant even among older patients considered "early".PreKT with KDPI>85% kidneys in older patients should be endorsed to improve utilization, optimize survival outcomes, shorten waiting times, and reduce waitlist mortality.