Identifying an appropriate KDPI max value for paediatric renal recipients

Introduction: Allocation of deceased donor kidneys to paediatric recipients aims to achieve HLA matching and longevity matching whilst minimising waiting time on dialysis. In order to enhance these outcomes the Australian renal allocation algorithm assigns points to recipients with an EPTS (estimated post transplant survival) of 25 and under to promote increased HLA matching in this population. An additional paediatric bonus is applied to the recipient score. 
The Royal Children’s Hospital renal transplant unit defines acceptable donor age and pathway criteria for their waiting list patients as part of the listing process; donors outside the specified range are excluded from the matching report by histocompatibility staff in our laboratory. However, there is capacity within the OrganMatch software to define an upper limit of acceptable KDPI, which excludes donors that exceed the upper value from the final match output. This review aimed to identify an appropriate KDPI Max value to apply within the OrganMatch software to automate the procedure of excluding donor offers unsuitable for the paediatric population.
Methods: A review of all deceased donor renal transplant renal recipients at a single local paediatric transplant centre between 2016 and 2024 was conducted to determine acceptable KDPI values. 
An additional review of unsuccessful allocation events between 2019 and 2022 was also performed, unsuccessful events were assigned to one of two categories.
Allocation events within age/pathway criteria declined for transplant.
Allocation events outside age/pathway criteria.
The aim was to identify a suitable upper KDPI threshold (KDPI Max) which could be applied within the OrganMatch allocation program to block unsuitable matches from allocation outcomes, while retaining matches suitable for consideration by the transplant unit.
Results: Amongst the transplanted cohort, the range of KDPI accepted for transplant was 0 - 67. 
29 allocation offers within acceptable age/pathway criteria were declined, with KDPI range of 3 – 80. 
A KDPI Max value of 80 was identified to be used in matching to exclude unsuitable offers. 
The KDPI Max value of 80 has been applied routinely to paediatric transplant waiting list recipients since November 2025.      
Conclusion: The application of a KDPI Max value for paediatric transplant waiting list recipients has reduced the need for histocompatibility staff to manually review age and pathway criteria to judge suitability of offers, whilst retaining potentially acceptable donation offers for further review by paediatric transplant unit.