Session Time: 5:30pm-6:30pm
Presentation Time: 5:30pm-6:30pm
Location: Exhibit Hall E
Since the initial definition of ECD established in 2002, their use worldwide has evolved unequally, resulting in a high discard rate. A better understanding of ECD outcomes and their determinants is urgently required to increase the rate of ECD transplantation and improve patient prognosis.
Patients who underwent kidney transplantations in 4 French referral centres between 2004 and 2011 were prospectively included in our population-based study. A systematic assessment of donor, recipient, and transplant clinical characteristics, preimplantation biopsy and baseline circulating DSA levels were performed. The long-term kidney allograft survival and the determinants of prognosis were assessed.
A total of 2,763 patients were included with 916/2,763 (33.2%) transplantations performed using ECDs. Overall, ECDs showed adequate but significantly lower kidney allograft survival compared to SCDs (80% vs. 88% at 7-years post-transplant, respectively, p<0.0001). A total of 335/2,763 patients (12.1%) had circulating DSA at the time of transplantation. We determined that ECD/DSA+ patients showed the poorest 7-year allograft survival (44%) compared with ECD/DSA- (85%), SCD/DSA+ (73%) and SCD/DSA- patients (90%, p<0.0001).
After adjustment for donor, recipient, and transplant characteristics, as well as preimplantation biopsy and baseline immunological parameters, we identified ECDs (HR=1.83; 95% CI [1.5-2.3]; p<0.0001), the presence of circulating DSA on the day of transplantation (HR=3.00; 95% CI [2.3-3.9]; p<0.0001) and an increased cold ischemia time >12 hours (HR=1.53; 95% CI [1.1-2.1]; p=0.0114) as the main independent determinants of long-term allograft loss. Recipients of ECD kidneys showed 41% and 12% improvements in 7-year allograft survival rates when they were screened and transplanted without circulating DSA and with a low (<12 hours) cold ischemia time (p<0.0001 and p=0.0299, respectively). These results were confirmed in an independent validation cohort.
ECD allocation policies should promote a reduced cold ischemia time below 12 hours combined with accurate screening for circulating anti-HLA DSA. Using these strategies, ECDs can yield satisfactory long-term results and increase the pool of donors in the context of organ shortages.
To cite this abstract in AMA style:Aubert O, Huyen Duongvan. Long-Term Outcomes of Transplantation Using Kidneys from Expanded Criteria Donors [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/long-term-outcomes-of-transplantation-using-kidneys-from-expanded-criteria-donors/. Accessed May 21, 2019.
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