Date: Monday, May 1, 2017
Session Name: Concurrent Session: Donors with Acute Kidney Injury
Session Time: 4:30pm-6:00pm
Presentation Time: 4:54pm-5:06pm
We analyzed UNOS data to determine how donor warm ischemic time (WIT), donor BMI, donor hypertension (dHTN), cold ischemic time (CIT), and vasopressin use in the peridonation period (ddAVP) influenced outcomes of kidney transplants from donors after cardiac death (DCD).
We evaluated all DCD kidney transplants performed in the United States from 1988-2013. Transplants with no recorded WIT or incomplete KDRI-required values (Kidney Donor Risk Index) were excluded. The effects of donor traits on graft and recipient survival were evaluated with Cox Regression and the Kaplan-Meier method. Effects on delayed graft function (DGF) was evaluated with Logistic regression.
This study included a total of 11907 DCD kidney transplants. Compared to kidneys with WIT<60 min, kidneys with WIT 60-79min had similar rates of graft failure (HR0.95, 95%CI 0.67-1.37), whereas those with WIT≥80min had 1.66 times more failure (HR1.66, 95%CI1.16-2.38, P<0.05). One year (90%±0.3%, 87%±2.7% vs. 82.1%±4.2%) and 5 year (69.4%±0.6%, 79%±4% vs. 62%±6.8%) survival were greater in kidneys with WIT<60 and 60-79, compared to those with WIT≥80min, respectively. WIT did not correlate with DGF or recipient survival.
Donor BMI, CIT, and ddAVP were all predictors of DGF (p<0.0001). Compared to grafts from donors with BMI<20, BMI 20-29 increased DGF odds 1.5 fold (OR1.54, 95%CI 1.36-1.75) and BMI>30 increased odds 2 fold (OR2.35, 95%CI 2.05-2.70). DGF odds were also higher with CIT 12-24hrs (OR1.52, 95%CI1.38-1.69) and CIT 24-48hrs (OR2.26, 95%CI2.01-2.55) in comparison to CIT<12hrs. ddAVP reduced DGF odds sizeably (OR0.7, 95%CI0.6-0.8).
Notably, dHTN increased recipient mortality (HR1.19, 95%CI1.02-1.38, p<0.05) but did not affect DGF (p=0.54) or graft failure (p=0.16). Donor BMI, CIT, and ddAVP did not predict recipient mortality.
WIT and CIT are significant predictors of DCD kidney graft survival, while CIT, donor BMI, and ddAVP are significant predictors of DGF. DCD kidneys with WIT≤80min may be acceptable without compromising graft survival. Grafts with WIT≥80min are more likely to result in graft failure and hence should only be considered in specific circumstances.
CITATION INFORMATION: Chen J, Mikhail D, Sharma H, Hijazi A, Nap D, Stitt L, Jevnikar J, Cooper M, Luke P, Sener A. Donor Warm Ischemic Time >80min Is an Important Predictor of Kidney Graft Survival from Donors After Cardiac Death. Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:Chen J, Mikhail D, Sharma H, Hijazi A, Nap D, Stitt L, Jevnikar J, Cooper M, Luke P, Sener A. Donor Warm Ischemic Time >80min Is an Important Predictor of Kidney Graft Survival from Donors After Cardiac Death. [abstract]. Am J Transplant. 2017; 17 (suppl 3). https://atcmeetingabstracts.com/abstract/donor-warm-ischemic-time-80min-is-an-important-predictor-of-kidney-graft-survival-from-donors-after-cardiac-death/. Accessed September 27, 2020.
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