Deceased donor kidneys are discarded at higher rates when labeled as high kidney donor profile index.

The kidney donor risk index (KDRI) and percentile conversion, kidney donor profile index (KDPI), provide a continuous measure of donor quality. Kidneys with a KDPI >85% (KDPI 85 ) are referred to as "high KDPI." The KDPI 85 cutoff changes every year, impacting which kidneys are labeled as KDPI HIGH . We examine kidney utilization around the KDPI 85 cutoff and explore the "high KDPI" labeling effect. KDRI to KDPI Mapping Tables from 2012 to 2020 were used to determine the yearly KDRI 85 value. Organ Procurement and Transplantation Network data was used to calculate discard rates and model organ use. KDRI 85 varied between 1.768 and 1.888. In a multivariable analysis, kidney utilization was lower for KDPI 86% compared with KDPI 85% kidneys (p = .046). Kidneys with a KDRI between 1.785-1.849 were classified as KDPI HIGH in the years 2015-2017 and KDPI LOW in the years 2018-2020. The discard rate was 44.9% when labeled as KDPI HIGH and 39.1% when labeled as KDPI LOW (p < .01). For kidneys with the same KDRI, the high KDPI label is associated with increased discard. We should reconsider the appropriateness of the "high KDPI" label.