Increasing kidney donor profile index sequence does not adversely affect medium-term health-related quality of life after kidney transplantation

Background: The United Network for Organ Sharing system allocates deceased donor kidneys based on the kidney donor profile index (KDPI), stratified as sequences (A <= 20%, B > 20-< 35%, C >= 35-= 85%, and D > 85%), with increasing KDPI associated with decreased graft survival. While health-related quality of life (HRQOL) may improve after transplantation, the effect of donor kidney quality, reflected by KDPI sequence, on post-transplant HRQOL has not been reported. Methods: Health-related quality of life was measured using the eight scales and physical and mental component summaries (PCS, MCS) of the SF-36 (R) Health Survey. Multivariable mixed effects models that adjusted for age, gender, rejection, and previous transplant and analysis of variance methods tested the effects of time and KDPI sequence on post-transplant HRQOL. Results: A total of 141 waitlisted adults and 505 recipients (> 1700 observations) were included. Pretransplant PCS and MCS averaged, respectively, slightly below and within general population norms (GPN; 40-60). At 31 +/- 26 months post-transplant, average PCS (41 +/- 11) and MCS (51 +/- 11), overall and within each KDPI sequence, were within GPN. KDPI sequence was not related to post-transplant HRQOL (P >.134) or its trajectory (interaction P >.163). Conclusion: Increasing KDPI does not adversely affect the medium-term values and trajectories of HRQOL after kidney transplantation. This may reassure patients and centers when considering using high KDPI kidneys.