Background. Kidney transplants (KTx) from standard (STD) DCD donors have higher rates of primary non function (PNF) and delayed graft function (DGF) than DBD but similar graft survival. Outcomes of expanded criteria (EC) DCD KTx remain unclear. Our experience with KTx from EC DCD donors is herein described. Methods. In this single-centre observational study with 5 years of follow up, we analyzed data from 112 consecutive primary single KTx from Maastricht category 3 DCD donors. Only patients receiving grafts preserved on cold storage and treated with Cyclosporine-MMF-steroid were included. Two groups were considered: STD (donor <60 years, 72 patients) and EC (donor ≥60 years, 40 patients). We used a Cox proportional hazards model to investigate risk factors for death and graft loss. Results. STD and EC showed different recipient (49.3, IQR 39.6-55.2 vs 59.4, IQR 55.4-63.9; p<0.001) and donor (42.5, IQR 29.5-51.8 vs 64, IQR 62-68; p<0.001) age whereas other characteristics were similar. After 5 years, recipients in EC showed inferior patient survival (66 vs 85%, P<0.05), death-censored graft survival (63 vs 83%, P<0.05), and MDRD GFR (34, IQR 27-42 vs 45, IQR 33-58 mL/min, P=0.081) than STD. The incidence of DGF and graft thrombosis was higher in EC than STD: 70 vs 47% (P<0.05) and 12.5 vs 1.4% (P<0.05). Cumulative rejection (Young 28 vs Old 20%), Polyomavirus infection, and PTLD rates were similar (P=ns). Donor age ≥60 years (HR 3.135, 95%CI 1.716-5.729, p<0.001) and type of induction (HR 0.503, 95%CI 0.269-0.940, p=0.031 with rabbit antithymocyte globulin in favour of graft survival) were predictors of transplant loss at multivariate analysis. Donor age ≥60 years was also predictor of patient death within the first posttransplant year (HR 2.433, 95%CI 1.178-5.447). Conclusions. EC Maastricht category 3 DCD donors show inferior patient and graft survival than standard donors of the same category. Donor age ≥60 years is the most important risk factor for death and early transplant loss. Meticulous evaluation of the recipient, careful donor-recipient matching, and anti-thymocyte globulin induction may improve outcomes. Multicenter prospective studies investigating survival benefit of EC DCD KTx over dialysis are encouraged.

CITATION INFORMATION: Favi E., Puliatti C., Iesari S., Ferraresso M., Cacciola R. Long-Term Outcomes of Primary Kidney Transplant from Expanded Criteria Maastricht Category 3 DCD Donors: A Single-Centre Observational Study Am J Transplant. 2017;17 (suppl 3).

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