Causes of 30 Day Graft Loss among Shared Kidneys in the National Kidney Registry (NKR)
1Georgetown University Hospital, Washington, DC, 2University of North Carolina, Chapel Hill, NC, 3National Kidney Registry, New York, NY, 4Johns Hopkins University, Baltimore, MD, 5UCLA, Los Angeles, CA, 6Cleveland Clinic, Cleveland, OH
Meeting: 2019 American Transplant Congress
Abstract number: B294
Keywords: Graft survival, Kidney transplantation
Session Information
Session Name: Poster Session B: Kidney Paired Exchange
Session Type: Poster Session
Date: Sunday, June 2, 2019
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall C & D
*Purpose: We have previously reported favorable 1 year graft survival of over 98% in the NKR. Many early concerns associated with organ travel, longer ischemic times, and cooperation between centers have been shown to have no negative impact on outcomes. However, there are a small number of early (30 day) graft losses that are troubling, and we sought to determine if there are any predictive factors for these untimely events.
*Methods: The NKR database linked and merged with SRTR files, was queried between February 2008 and December 2017, representing 2363 NKR transplants. We compared the demographics, kidney anatomy, histocompatibility, transportation logistics, transplant surgery, and post op events of survivors to those with 30 day graft losses.
*Results: Of 2363 total NKR transplants, there were 12 (0.5%) 30-day and 37 (1.6%) 1-year graft losses. For those with early graft loss, there were no statistically significant differences in demographics (sex, race, age, BMI, or donor eGFR/CrCl), ABO compatibility, HLA mismatch, numbers of renal vessels, cold ischemia or travel times when compared to the remainder of the NKR transplants. 17% were right kidneys, and had no increased risk of early loss. Of the 12 early failures, 2 were due to venous thrombosis and 2 arterial thrombosis with reoperation, 2 failure of desensitization with ABMR, and one abdominal sepsis/shock. There were 5 that never functioned without a clear cause for failure.
*Conclusions: Early graft loss is extremely rare despite the challenges of KPD. We were unable to detect new predictive risk factors for early graft loss in our KPD population. Although multiple vessels or aggressive desensitization were found in the cohort of early losses and are known to convey some increased surgical and immunologic risk, they did not rise to the level of statistical significance. Cold ischemic time/time to travel did not lead to excess early graft loss. Maximizing communication between donor and recipient centers offers the best opportunity to minimize these rare but extremely unfortunate events.
To cite this abstract in AMA style:
Verbesey J, Thomas A, Ronin M, Segev D, Waterman A, Flechner S, Cooper M. Causes of 30 Day Graft Loss among Shared Kidneys in the National Kidney Registry (NKR) [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/causes-of-30-day-graft-loss-among-shared-kidneys-in-the-national-kidney-registry-nkr/. Accessed May 18, 2025.« Back to 2019 American Transplant Congress