{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T00:20:10Z","timestamp":1773015610760,"version":"3.50.1"},"reference-count":33,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,2,4]],"date-time":"2026-02-04T00:00:00Z","timestamp":1770163200000},"content-version":"vor","delay-in-days":3,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,2,1]],"date-time":"2026-02-01T00:00:00Z","timestamp":1769904000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Transplantation"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The allocation and acceptance of deceased\u2010donor kidneys in the United States is influenced by theKidney Donor Profile Index (KDPI). We conducted a national analysis of high\u2010KDPI kidney transplants performed from 2014 to 2021 to identify key predictors of post\u2010transplant outcomes beyond those incorporated in KDPI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective cohort study used data extracted from the Scientific Registry of Transplant Recipients (SRTR). Adult, first\u2010time recipients of kidney\u2010only deceased\u2010donor transplants with KDPI greater than 85% were included. Regression models were used to identify independent predictors of delayed graft function (DGF), primary graft nonfunction (PGNF), patient survival, overall graft survival, and death\u2010censored graft survival.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 4,911 recipients, DGF occurred in 33.8% and PGNF in 4.0%. DGF was independently associated with donation after circulatory death, terminal donor creatinine &gt; 1.5\u00a0mg\/dL, recipient obesity, dialysis duration &gt; 3 years, and cold ischemia time (CIT) \u2265 24 h, whereas machine perfusion was protective. PGNF was associated with donation after circulatory death, terminal donor creatinine &gt; 2.0\u00a0mg\/dL, high\u2010risk cytomegalovirus (CMV) serostatus, and donor injury patterns within the high\u2010KDPI range, including younger donor age. Five\u2010year patient and graft survival were 72% and 62%, respectively. Graft loss was independently associated with DGF, elevated intrarenal resistive index (RI), recipient diabetes, prolonged dialysis exposure, and high\u2010risk CMV\/EBV serostatus.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Outcomes after high\u2010KDPI kidney transplantation reflect both KDPI\u2010defined donor risk and additional recipient, immunologic, and perioperative factors. A multidomain, offer\u2010time assessment may support more individualized acceptance decisions and improve utilization.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ctr.70472","type":"journal-article","created":{"date-parts":[[2026,2,4]],"date-time":"2026-02-04T20:51:27Z","timestamp":1770238287000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["\u201cRethinking High\u2010KDPI Kidneys: A Multidomain Approach to Predicting Success\u201d"],"prefix":"10.1111","volume":"40","author":[{"given":"Xingyu","family":"Zhang","sequence":"first","affiliation":[{"name":"Biostatistics and Epidemiology, School of Health and Rehabilitation Sciences University of Pittsburgh  Pittsburgh Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4856-9242","authenticated-orcid":false,"given":"Chethan","family":"Puttarajappa","sequence":"additional","affiliation":[{"name":"Department of Medicine Division of Nephrology University of Pittsburgh Medical Center  Pittsburgh Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frank","family":"Spitz","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Abdominal Transplantation University of Pittsburgh Medical Center  Pittsburgh Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jason","family":"Mial\u2010Anthony","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Abdominal Transplantation University of Pittsburgh Medical Center  Pittsburgh Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0321-4365","authenticated-orcid":false,"given":"Berkay","family":"Demirors","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Abdominal Transplantation University of Pittsburgh Medical Center  Pittsburgh Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abiha","family":"Abdullah","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Abdominal Transplantation University of Pittsburgh Medical Center  Pittsburgh Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vrishketan","family":"Sethi","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Abdominal Transplantation University of Pittsburgh Medical Center  Pittsburgh Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew Yu\u2010Sheng","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Surgery, School of Medicine, College of Medicine Kaohsiung Medical University  Kaohsiung Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew","family":"Crane","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Abdominal Transplantation Willis Knighton J. 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McDonald Transplant Center  Shreveport Louisiana USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Winn","family":"Cashion","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Nephrology Maine Health  Portland Maine USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Charbel","family":"Elias","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Abdominal Transplantation University of Pittsburgh Medical Center  Pittsburgh Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Han","family":"Shwe","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Abdominal Transplantation University of Pittsburgh Medical Center  Pittsburgh Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Timothy","family":"Fokken","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Abdominal Transplantation University of Pittsburgh Medical Center  Pittsburgh Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bradley","family":"Phelp","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Abdominal Transplantation University of Pittsburgh Medical Center  Pittsburgh Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ryugen","family":"Takahashi","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Abdominal Transplantation University of Pittsburgh Medical Center  Pittsburgh Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hao","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Abdominal Transplantation Houston Methodist J.C. 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