Non- Superior Patient and Death-Censored Graft Survival with Controlled after Cardiac Death Donors Than Expanded Criteria Brain Death Donors in Older Recipients Over 60 Years, with Better Outcomes with Living Kidney Donors

I. Revuelta¹, D. Cucchiari¹, A. Ruiz², E. De Sousa-Amorim¹, D. Paredes², L. Peri³, P. Ventura-Aguiar¹, M. Musquera³, N. Esforzado¹, F. Cofan¹, J. V. Torregrosa¹, G. J. Piñeiro¹, J. Ugalde-Altamirano¹, J. M. Campistol¹, F. Oppenheimer¹, F. Diekmann¹

¹Renal Transplant Unit, Department of Nephrology and Kidney Transplant, Hospital Clinic, Barcelona, Spain, ²Donation and Transplant Coordination Section, Hospital Clinic, Barcelona, Spain, ³Department of Urology, Hospital Clinic, Barcelona, Spain

Meeting: 2020 American Transplant Congress

Abstract number: C-057

Keywords: Donation, Donors, marginal, Graft survival, Kidney transplantation

Session Information

Session Name: Poster Session C: Kidney Living 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: Each time transplant candidates are older, and the allocation of suitable donors is a real challenge. Controlled Donors after Cardiac Death (cDCD) are using as an approach to increase donor pool, with controversies in the use of expanded cDCD due to worse patient survival with similar death-censored graft survival than other source of donors, even considering expanded living kidney donors (LKD). The aim of this study is to evaluate the results of the strategies to increase the donor pool for recipients over 60 years.

*Methods: 311 recipients over 60yrs in our hospital (2014-2018). cDCD and expanded criteria donors (ECD) were evaluated with procurement parameters, pre-implant kidney biopsy, and hypothermic pulsatile machine, and LKD following recommendation guidelines. Immunosupression protocols were used according immune, delay graft function (DGF) and neoplasia risk, with a standard maintenance protocol based of tacrolimus, everolimus and steroids. The study was approved by the Local Ethical Committee.

*Results: 99 cDCD, 165 ECD, and 47 LKD for 311 recipients over 60yrs were followed during 20.9±16.4, 25.7±17.9, and 28.49±19.2 months respectively(p=0.028). Worse patient survival (p=0.016) and graft survival(p=0.025) in cDCD(13.1%;19.2%) than LKD(2.3%;4,3%) without differences(p=0.490;p=0.493) with ECD(14.5%;20%) were found. Thymo induction(p=0.000), donor age(p=0.000), and DGF(p=0.000) were the statistical significant differences between the three options of donors, but in the multivariant analysis for patient survival only the DGF and LKD vs cDCD were found significative(p=0.001;p=0.036), and for graft survival only the DGF(p=0.000), being DGF associated with the type of donors(p=0.003) in the multivariant analysis. Considering only donors over 60yrs (75-cDCD, 132-ECD, 32-LKD; FU 20.3±15.4, 26.0±17.8, 26.4±18.9 p=0.059), same results in thymo(p=0.000), DGF(p=0.000), and donor age(p=0.000) were found, with higher rate of mTOR inhibitor(p=0.003) in both deceased donors. In the multivariant analysis for patient and graft survival only DGF(p=0.002) were found, being the type of donors the only statistical significant factor found associated with DGF(p=0.032).

*Conclusions: In recipients over 60yrs, LKDs, even old LKDs, have better patient and graft survival without differences between cDCD and ECD. Although thymo and donor age are risk factors in the univariant analysis, only DGF was found in the multivariant analysis.

To cite this abstract in AMA style:

Revuelta I, Cucchiari D, Ruiz A, Sousa-Amorim EDe, Paredes D, Peri L, Ventura-Aguiar P, Musquera M, Esforzado N, Cofan F, Torregrosa JV, Piñeiro GJ, Ugalde-Altamirano J, Campistol JM, Oppenheimer F, Diekmann F. Non- Superior Patient and Death-Censored Graft Survival with Controlled after Cardiac Death Donors Than Expanded Criteria Brain Death Donors in Older Recipients Over 60 Years, with Better Outcomes with Living Kidney Donors [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/non-superior-patient-and-death-censored-graft-survival-with-controlled-after-cardiac-death-donors-than-expanded-criteria-brain-death-donors-in-older-recipients-over-60-years-with-better-outcomes-wit/. Accessed May 16, 2025.

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