Kidney Transplantation from Extended-Criteria Donors: An Increased Risk of Ureteral and Urinary Complications? Study from 10279 Patients
1Department of Urology, Chu Nantes, Nantes Université, ITUN, Nantes, France, 2Department of Methodology And Biostatistics, Nantes, Nantes Université, Methodology And Biostatistics Platform, Nantes, France, 3Department of Surgical Sciences, Nuffield Department of Surgical Sciences, Oxford Transplant Centre, Oxford University Hospitals, University of Oxford, Oxford, United Kingdom
Meeting: 2020 American Transplant Congress
Abstract number: D-017
Keywords: Donors, marginal, Kidney transplantation, Machine preservation, Risk factors
Session Information
Session Name: Poster Session D: Kidney Deceased Donor Selection
Session Type: Poster Session
Date: Saturday, May 30, 2020
Session Time: 3:15pm-4:00pm
Presentation Time: 3:30pm-4:00pm
Location: Virtual
*Purpose: Due to the increasing need for kidneys suitable to transplantation, the scientific comunity has expanded the donor population to include extended criteria donors (ECD). Although the use of ECD organs has increased, the implication of such a strategy in terms of urological and ureteral complications has been only marginally analysed. The objective of this work is to evaluate the impact of EDCs on urologic complications.
*Methods: Between January 1, 2002 and December 31, 2017, 10279 kidney transplants on adult recipients were recorded within the DIVAT network (Données Informatisées et VAlidées en Transplantation /Computerized and VAlidated Data in Transplantation). Data were extracted from the entire network in relation to 137 pre- and post-operative variables regarded as relevant to the development of urological complications. ECD status was included, according to UNOS (United Network for Organizational Sharing) definition. (Extended criteria Donor) .Univariate and multivariate analysis were performed to detect any correlation between the variables and urological complications at 1 year. The main analysis focused on the association between the donor’s ECD status and all urological complications at 1 year and then among the stenosis, fistula and reflux subgroups.
*Results: The donor’s ECD status was significantly associated with an increased risk of urologic complications at 1 year in univariate analysis (OR: 1.66 (1.47-1.88), p <0.001, RR: 1.374). Multivariate analysis confirmed this association (OR: 1.50 (1.31-1.71), p <0.001). Additional analysis showed that ECD status was significantly associated with ureteral stenosis at 1 year (OR: 1.70 (1.40-2.05), p <0.001, RR: 1.498), ureteral fistulas at 1 year (OR: 1, 62 (1.30-2.03), p <0.001, RR: 1.504) but not ureteral reflux at 1 year (OR 0.89 (0.62-1.27), p <0.532). The perfusion with ypothermic pulsatile machine did not reduce the risk of urological complications at 1 year. The placement of a JJ stent confirmed beneficial in preventing urological complications in all donors (ECD and not).
*Conclusions: The donor’s ECD status is associated to higher likelihood of stenoses and ureteric fistulas at 1 year. Recipients of grafts from an ECD donors should probably be considered for closer urological monitoring and systematic preventive measures to reduce the associated risk of these complications.
To cite this abstract in AMA style:
Mesnard B, Leroy M, Karam G, Neri F, Glemain P, Perrouin-Verbe M, Vergie SDe, Bouchot O, Rigaud J, Cantarovich D, Blancho G, Giral M, Branchereau J. Kidney Transplantation from Extended-Criteria Donors: An Increased Risk of Ureteral and Urinary Complications? Study from 10279 Patients [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/kidney-transplantation-from-extended-criteria-donors-an-increased-risk-of-ureteral-and-urinary-complications-study-from-10279-patients/. Accessed May 11, 2025.« Back to 2020 American Transplant Congress