Early Outcomes and Risk Factors after Five Years of a Nationwide Strategy for Kidney Transplantation with Controlled Circulatory Death Donor (cDCD)

J. Portoles,^1,2 M. Perez Saez,² D. Hernandez,² J. Juega,² F. Moreso,² N. Maruri,² P. Lopez,^1,2 E. Melilli,² D. Navarro,² E. de Souza,² J. Ruiz,² M. Mazuecos,² A. Gutierrez,² I. Perez-Flores,² D. Janeiro,^1,2 J. Pascual.²

¹Nephrology, H Puerta de Hierro, Madrid, Spain
²Nephrology, Spanish Multicentre Sentra-GEODAS Group, Madrid, Spain.

Meeting: 2018 American Transplant Congress

Abstract number: B110

Keywords: Donors, Kidney transplantation, non-heart-beating

Session Information

Session Name: Poster Session B: Kidney Deceased Donor Allocation

Session Type: Poster Session

Date: Sunday, June 3, 2018

Session Time: 6:00pm-7:00pm

Presentation Time: 6:00pm-7:00pm

Location: Hall 4EF

Study: prospective multicentre, systematic inclusion of every kidney transplants-KTx from controlled donation after circulatory death (cDCD) at joined units. Local center surgical and immunosuppressive protocols.

Background: cDCD programs are running in US and has recently started on Europe. National Tx organization (ONT) has developed a nationwide program in Spain from Jan12 and 45 Centers had progressively joined. 21 centers have entered our study group.

Results: 335 cDCD, donors aged 57.5 [19-81] year who have died mainly due to CV events (72%). 77 transferred out of our group. Use of extended criteria donnors has progressively increased. During the last 5 years (2012-16), 566 ESRD pat receive a KTx (56.5y [19-83]), for 91.9% of them were the first KTx. IS regimen included 98.8% induction (Thymoglobulin 67.1%/Basiliximab 32.3) plus prednisone-MMF-Tacrolimus (83.1%) or mTOR (6.9%). Median Cold ischemia (CIT) was 12.3h and warm IT 24min. Median HLA-mismatch was 4 [0-5].

Clinical outcomes: PGF rate was 3.4% mainly associated to preservation or vascular problems, no single hyperacute rejection case. DGF (defined as HD after KTx). In spite of DGF rate of 48.8% and after a mean follow-up of two years (1-5 year). The death censored graft survival was 97.4 & 95.7% at 1 & 2yr , graft and patient survival was 94.1 & 91.8% at 1 & 2yr. Multivariate risk factor associated to outcomes are shown in Table 1.

Risk factors associated to Primary Non Function	PNF	Function	p	OR multivariate
Cold Isquemia Time >=15h (%)	69.2	34	0.01	4.4 [1.3-14.4]
Risk factors associated to Delay Graft Function	DGF	Inmediate Function	p	OR multivariate
Donor age (years, mean (SD))	58.8 (11.1)	55.8 (12.0)	0.001	1.02 [1.01-1.03]
Previous HD vs PD (%HD)	84.2	67.3	0.001	2.1 [1.3-3.3]
Cold Isquemia Time >=15h (%)	39.4	28.9	0.02	1.6 [1.1-2.3]

Conclusions: KTx with cDCD present higher DGF than historic reference for brain death donor but similar PGF rate and patient or graft survival rates. CIT is the only modifiable risk factor for DGF and PGF. Our results aim us to promote this cDCD all over the country.

CITATION INFORMATION: Portoles J., Perez Saez M., Hernandez D., Juega J., Moreso F., Maruri N., Lopez P., Melilli E., Navarro D., de Souza E., Ruiz J., Mazuecos M., Gutierrez A., Perez-Flores I., Janeiro D., Pascual J. Early Outcomes and Risk Factors after Five Years of a Nationwide Strategy for Kidney Transplantation with Controlled Circulatory Death Donor (cDCD) Am J Transplant. 2017;17 (suppl 3).

To cite this abstract in AMA style:

Portoles J, Saez MPerez, Hernandez D, Juega J, Moreso F, Maruri N, Lopez P, Melilli E, Navarro D, Souza Ede, Ruiz J, Mazuecos M, Gutierrez A, Perez-Flores I, Janeiro D, Pascual J. Early Outcomes and Risk Factors after Five Years of a Nationwide Strategy for Kidney Transplantation with Controlled Circulatory Death Donor (cDCD) [abstract]. https://atcmeetingabstracts.com/abstract/early-outcomes-and-risk-factors-after-five-years-of-a-nationwide-strategy-for-kidney-transplantation-with-controlled-circulatory-death-donor-cdcd/. Accessed November 24, 2024.

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