Donor Comorbidities Rather Than Age Alone Determine Recipient Outcomes in "SCD" Kidney Transplants
The Transplant Institute, Henry Ford Hospital, Detroit, MI
Meeting: 2013 American Transplant Congress
Abstract number: C1267
Deceased donor (DD) pool has been expanded with kidneys that have wide-ranging functional vitality and pathologic features stemming from increasing incidence of metabolic syndrome. To date, D age is considered as predictor of graft (G) loss. Duration and severity of comorbidities may be the determinant of physiological age of an organ. It is our hypothesis that G outcomes may be a function of D hypertension rather than age.
We conducted a retrospective observational data analysis of DD recipients (R) using UNOS cohort of adult deceased DDR and identified R whose D were 40-49 and 30-39 years of age and met 2 of the 3 ECD criteria: history of hypertension, serum creatinine of >1.5 mg/dl and who died of CVA. We referred to these as ECD40sR and ECD30sR respectively. Control group was SCD50sR (D aged 50-59 without ECD criteria or hypertension). Excluded were re transplant, dual and multi-organ transplant R. Median follow up was 4 years. Kaplan Meier survival and Cox regression analyses for patient (PS) and graft survival (GS) were performed to compare ECD40sR, and ECD30sR with SCD50sR. Several D, R and transplant variables were included in regression analysis. Graft failure was defined as retransplantation or return to dialysis and censored for death.
Results: Although unadjusted analysis showed variable PS, on regression analysis, there was no effect on PS between the study groups (figures not included in abstract).
| Study Groups(N) | Hazard Ratio | 95% Confidence Interval | p value |
| SCD50sR (3807) vs ECD40sR (3158) | 0.94 | 0.80-1.1 | 0.44 |
| SCD50sR (5553) vs ECD30sR (1001) | 0.98 | 0.69-1.39 | 0.91 |
However, GS appeared to be significantly higher in SCD50sR (33%) compared to ECD40sR. SCD50sR appeared to have significantly higher GS (53%) compared to ECD30sR.
| Study Groups(N) | Hazard Ratio | 95% Confidence Interval | p value |
| SCD50sR (3807) vs ECD40sR (3158) | 0.75 | 0.64-0.88 | 0.0003 |
| SCD50sR (5552) vs ECD30sR (1001) | 0.65 | 0.47-0.9 | 0.01 |
It appears that recipients of younger D kidneys with ECD defined comorbidites have inferior GS when compared to recipients of older SCD kidneys without comorbidities raising the possibility of arteriolosclerosis in donor kidneys with its effects on glomerulosclerosis, interstitial fibrosis and tubular atrophy. Influence of other risk factors including components of the metabolic syndrome needs to be studied in this group of donors.
To cite this abstract in AMA style:
Patel A, Goggins M, Malinzak L, Karthikeyan V, Venkat K, Kim D, Denny J, Abouljoud M. Donor Comorbidities Rather Than Age Alone Determine Recipient Outcomes in "SCD" Kidney Transplants [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/donor-comorbidities-rather-than-age-alone-determine-recipient-outcomes-in-scd-kidney-transplants/. Accessed November 22, 2024.« Back to 2013 American Transplant Congress