Deceased Donor Issues (Videos Available)

Monday July 02, 2018 from 09:45 to 11:15

Room: N-103

317.8 Kidney transplantation from uncontrolled donors after circulatory death: Data from an observational cohort (Video Available)

Natividad N Calvo Romero Sr., Spain

Dr
Transplant
HOSPITAL CLINICO SAN CARLOS

Abstract

Kidney Transplantation from Uncontrolled Donors after Circulatory Death: Data from an Observational Cohort

Natividad Calvo Romero1, Isabel I Perez Flores P1, Beatriz B Rodriguez Cubillo R1, M.Angeles M Moreno de la higuera M1, Marta M Calvo Arevalo C1, Jesus j Blazquez B1, Angel A Gomez G1, Jesus J Moreno m1, Francisco F Del Rio D1, Ana A Sanchez Fructuoso S1.

1Transplant, Hospital Clinico San Carlos, MADRID, Spain

Kidney transplantation from controlled donors after circulatory death (DCD) has substantially increased in Europe and the USA in the last decade,allowing for an increase in the amount of kidney transplants performed, obtaining good long-term results. However, there is scarce information on the long-term resultsof kidney transplantation from uncontrolled DCD (uDCD) We report the largest single-center series of kidney transplants from uDCD.
Aim: To analyze the factors that can be predictive of graft loss due to TMA in uDCD.
Methods: Observational cohort study that included all kidney recipients fromuDCD (n=774) and from donors after brain death (DBD) (N=613) performed in our center between 1996 and 2015. Recipients from DBD were divided into two groups: standard criteria brain death donors (SCBD) (n=366), and expanded criteria brain death donors (ECBD) (n=247). Clinical outcomes were compared.
Results: After the introduction of kidney transplantation fromuDCD,the median waiting time on the kidney transplant listfor patients in dialysis decreased from 25.1 months (IQR 13.0-54.9) to 12.9 months (IQR 5.6-24.8), and 107 patientswere transplanted pre-emptively. One, 5 and 10-year graft survival rates for SCBD were 91.7%, 86.2% and 81.3% respectively versus 86.0%, 75.7% and 61.3% for ECBD and 85.1%, 79.2% and 73.3% for uDCD (p<0.001). Graft survival in transplants from uDCD donors was worse than those from SCBD (p=0.028) but better than in those from ECBD (p=0.028). The main cause of graft loss in uDCD was primary nonfunction, mainly due to thrombotic microangiopathy. Multivariate Cox regression analysis for graft loss (censored for death) showed an association between the presence of delayed graft function (DGF) and donor type. In presence of DGF, kidney transplant recipients from DBD had a higher risk of graft loss, both those from SCBD (HR 1.79 95% CI 1.08-2.99) and ECBD (HR 2.75,95% CI 1.67-4.51). In absence of DGF, recipients from ECBD had a higher risk of graft loss.



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