Date: Saturday, May 30, 2020
Session Time: 3:15pm-4:00pm
Presentation Time: 3:30pm-4:00pm
*Purpose: The dialysis burden in patients with end stage renal disease (ESRD) awaiting a kidney transplant (KT) is a huge driver of morbidity, mortality, and social cost. Meanwhile, thousands of deceased-donor (DD) kidneys that almost certainly have better outcomes than dialysis are discarded each year. Our center actively sought to identify and transplant kidneys that would reduce waiting time for patients while preserving post-transplant outcomes consistent with nationally expected results.
*Methods: We retrospectively analyzed 694 consecutive DDKT recipients transplanted between 10/2016 – 03/2019 at our center. Primary endpoints were eGFR(MDRD) at 1 yr post-transplant and death-censored graft survival using Kaplan-Meier survival estimation and the Cox Proportional Hazards Model. A stepwise multivariate regression analysis of variables hypothesized to affect eGFR at 1 yr was performed. We reviewed 5 yrs of transplants and summarized the impact of this increased utilization on waiting time with an emphasis on historically underrepresented blood groups and racial/ethnic identification.
*Results: DDKT cohort volumes were 94.1% larger in the last quarter than the first (99 vs. 51, annualized at 396 DDKTs per year). Increase in growth was entirely attributable to increased acceptance of hard-to-place imported kidneys, including kidneys with AKI (324% increase) and KDPI > 85 (420% increase). In the first quarter, 33.3% of DD kidneys were imported and by the last quarter, 76.8% were imported. Overall one-year patient survival was 96.8% (p=0.0067, CI: 95.2-97.8%) and death-censored 1 yr graft survival was 96.43% (p=0.0072 CI: 94.71%-97.59%). Graft survival at 1 yr was indistinguishable between recipients with any stage of AKI versus donors without AKI (p=0.439, CI=95%), and KDPI >85% survival at 1 yr was 93% vs 97.2% with KDPI <85% (p=0.062). Consequently, waiting time accrual significantly decreased at transplant across all blood types (6.4 yrs in 2015 to 3.9 yrs in 2019). This benefit was even greater for blood group B (10.7 to 4.3), and significantly reduced the disparity in accrued waiting times for African-American and Hispanic populations. Mean eGFR (MDRD) at 1 year was 59.813 ± 21.571 in recipients with non-AKI donors and 57.093 ± 24.714 in recipients with AKI donors (p=0.1048, CI=95%), not significant; while 1-yr mean eGFR was 48.7 ml/min/1.73m2 in the KDPI > 85% group vs 60.8 ml/min/1.73m2 in the < 85% KDPI group, a statistically significant difference (p=0.001).
*Conclusions: Across the nation, transplant centers must answer the growing demands of patients enduring dialysis to better utilize kidneys that have previously been discarded. Our center has demonstrated that it is possible to double DDKT volume, substantially reduce waiting time, and maintain excellent outcomes using kidneys previously discarded. An ongoing study is essential to ensure long term outcomes validate our mission of finding the right kidney for the right recipient.
To cite this abstract in AMA style:Guerra G, Preczewski L, Harshman A, Ciancio G, Vianna R, Figueiro J, Muldoon M. A Call to Action: Finding the Right Kidney for All Potential Recipients [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/a-call-to-action-finding-the-right-kidney-for-all-potential-recipients/. Accessed January 19, 2021.
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