Kidney Transplantation in Very Highly-Sensitized Patients with Maastricht Type III Non-heart-Beating Donors
1Department of Nephrology, Hospital Puerta del Mar, Cadiz, Spain, 2Department of Nephrology, Hospital Carlos Haya, Malaga, Spain, 3Department of Nephrology, Hospital Virgen del Rocio, Sevilla, Spain, 4Department of Nephrology, Hospital Reina Sofia, Cordoba, Spain, 5Department of Nephrology, Hospital Virgen de las Nieves, Granada, Spain, 6Andalusian Transplant Coordination, Sevilla, Spain
Meeting: 2021 American Transplant Congress
Abstract number: 31
Keywords: Donors, non-heart-beating, Graft survival, Highly-sensitized, Kidney transplantation
Topic: Clinical Science » Kidney » Kidney Deceased Donor Allocation
Session Information
Session Name: Kidney Deceased Donor Allocation
Session Type: Rapid Fire Oral Abstract
Date: Saturday, June 5, 2021
Session Time: 4:30pm-5:30pm
Presentation Time: 4:50pm-4:55pm
Location: Virtual
*Purpose: In 2012, a kidney transplant (KT) program for very highly-sensitized (VHS) patients (PRA ≥ 95%) based on virtual crossmatch began in Andalusia (Spanish region). Initially these patients used to receive grafts from brain-death donor (BDD). However, the development of Maastricht type III non-heart-beating donation (NHBD) in Spain led to the incorporation of these donors in 2018 in order to increase the donation pool.
*Methods: Retrospective cohort study of deceased donor KT recipients within the Andalusian VHS patient program from August 2012 to April 2020. To compare the results between BDD and NHBD KT, we performed a case-control study with a minimum follow-up of 3 months. For each case of NHBD, the 4 closest BDD controls were selected according to the KT date. Clinical and demographic variables were analyzed. Kaplan Meier survival analysis and Cox regression multivariate analysis were performed for graft survival risk factors.
*Results: During this period, 172 KT were performed in Andalusia in VHS patients, of which 26 belongs to NHBD.
A total of 130 KT were selected according to inclusion criteria (4 BDD: 1 NHBD). The median follow-up time was 547.5 days. Of them, 54.6% were women with a mean age of 50.4 years. A 68.5% of the patients received prior KT and they had a median PRA of 98% [96, 99]. The median time on the waiting list was 1487.5 days and 345 days since their inclusion in the VHS program until KT. Graft survival in the first year after KT was 90.5%. There were no differences when comparing graft survival between BDD and NHBD (p = .184). In the multivariate analysis, an older donor age and time preKT on renal replacement therapy were risk factors for graft survival. The age of the recipient was a protective factor.
*Conclusions: The exchange based on virtual crossmatch facilitates the access to KT in VHS patients, shortening the time on the waiting list. In our program, the donor and recipient age and the time on renal replacement therapy influenced graft survival, but not the type of donor, so Maastricht type III NHBD may be considered a valid option for VHS patients.
To cite this abstract in AMA style:
Villanego F, Mazuecos A, Vigara L, Lopez V, Bernal G, Rodriguez-Benot A, Gracia Mde, Castro P, Alvarez A. Kidney Transplantation in Very Highly-Sensitized Patients with Maastricht Type III Non-heart-Beating Donors [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/kidney-transplantation-in-very-highly-sensitized-patients-with-maastricht-type-iii-non-heart-beating-donors/. Accessed May 17, 2025.« Back to 2021 American Transplant Congress