Detriemental Impact of DGF and CIT On Longterm Survival After Kidney Transplantation in Elderly Recipients

C. Denecke,^1,2 M. Biebl,^1,2 C. Bösmüller,² F. Aigner,^1,2 T. Dziodzio,^1,2 R. Sucher,^1,2 S. Weiss,² J. Pratschke,^1,2 R. öllinger.^1,2

¹Allgemein, Viszeral –
und Transplantationschirurgie, Charite Virchow Klinikum, Berlin, Germany
²Viszeral, Transplantations –
und Thoraxchirurgie, Medizinische Universität Innsbruck, Innsbruck, Austria.

Meeting: 2015 American Transplant Congress

Abstract number: B121

Keywords: Donors, Ischemia, Kidney, marginal

Session Information

Session Name: Poster Session B: Kidney Complications: Late Graft Failure

Session Type: Poster Session

Date: Sunday, May 3, 2015

Session Time: 5:30pm-6:30pm

Presentation Time: 5:30pm-6:30pm

Location: Exhibit Hall E

Background: In kidney transplantation, the association of cold ischemia time (CIT) and delayed graft function (DGF) is particularly detriemental in grafts from marginal donors. In this study, the influence of ischemia times and associated factors on longterm survival in elderly Ktx recipients were analyzed.

Methods: Data from 1247 patients transplanted between 2000 and 2010 at the Department of Surgery, Innsbruck, were retrospectively analyzed. The age-dependent longterm outcome was investigated.

Results: Patients >65 years (n=193) had a significantly lower graft and patient survival (1yr,5yr and 10yr, old vs.young: 91.7%,71.2% and 50.6% vs.96.1%,89.1% and 79.2%, p<0.001) than younger patients <65 yrs (n=1054). However, death-censored graft survival was age-independent. In a univariate analysis, patients >65years received significantly more ECD/DCD grafts, grafts with a higher degree of arteriosclerosis, had a higher donor age but a shorter CIT. Interestingly, rates of DGF and acute rejection were comparable.

Next, the age-dependent impact of DGF was analyzed. In patients <65 years with DGF, 10 year survival was significantly lower compared to patients without DGF (p<0.05). In contrast, graft survival but not patient survival was impaired by DGF in patients >65 years.

Furthermore, the association of CIT and type of donor (DCD, ECD vs. SCD) was examined. The risk of graft loss for ECD grafts but not SCD grafts was markedly increased beyond 800min CIT. Consequently, a CIT >878min) was associated with reduced survival of ECD but not SCD grafts.

On multivariate analysis, recipient age and DGF were independent risk factor for patient survival in younger recipients (p<0.0005). Likewise, recipient age, donor age, induction therapy and DGF were risk factors for impaired graft survival. In contrast, in patients >65years, risk factors for patient survival were age and induction therapy but not DGF while donor age, induction therapy and DGF affected graft survival.

Conclusion: DGF rates have a negative independent impact on graft and patient survival. While CIT was shorter in elderly recipients, it was associated with impaired survival of ECD grafts. Thus, it is particularly important to further reduce CIT in elderly transplant recipients of ECD grafts

To cite this abstract in AMA style:

Denecke C, Biebl M, Bösmüller C, Aigner F, Dziodzio T, Sucher R, Weiss S, Pratschke J, öllinger R. Detriemental Impact of DGF and CIT On Longterm Survival After Kidney Transplantation in Elderly Recipients [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/detriemental-impact-of-dgf-and-cit-on-longterm-survival-after-kidney-transplantation-in-elderly-recipients/. Accessed November 23, 2024.

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