Recipient Outcomes of DCD Kidneys with and without Donor TPA Administration
Miami Transplant Institute, Miami, FL
Meeting: 2020 American Transplant Congress
Abstract number: A-235
Keywords: Cadaveric organs, Donation, Kidney/liver transplantation, Renal thrombosis
Session Information
Date: Saturday, May 30, 2020
Session Name: Poster Session A: Deceased Donor Management and Intervention Research
Session Time: 3:15pm-4:00pm
Presentation Time: 3:30pm-4:00pm
Location: Virtual
*Purpose: Our OPO utilizes a TPA administration protocol for DCD liver donors to be transplanted at our center. This results in a series of DCD kidneys also transplanted at our center, some of which (livers placed at our center) were from DCD donors given TPA after death and others of which (livers allocated to another center or discarded) were from DCD donors not given TPA. We reviewed these transplants to identify whether donor TPA administration affected outcomes.
*Methods: We retrospectively analyzed 53 consecutive transplants of local DCD kidneys transplanted between 10/2016 and 03/2019 at our center. Primary endpoints were eGFR by MDRD equation at 1-year post-tx and incidence of post-op hematoma. 43 patients survived with function and f/u at 1 year. Patient and death-censored graft Kaplan-Meier survival curves were compared by Cox Proportional Hazards Model. Means of risk factors known to impact 1-year eGFR at our center were compared with a t-test. Rates of surgical complications were assessed with Fisher’s Exact Test.
*Results: The groups were not significantly different in KDPI, cold ischemic time, final resistance on pump, or % glomerulosclerosis. Of note, while none of these differences were significant, all 4 known risk factors had higher values in the non-TPA group.
| Donor TPA | No Donor TPA | p-value (t-test) | |
| n | 24 | 19 | |
| KDPI | 56.1 | 58.6 | NS |
| CIT | 25.6 | 29.4 | NS |
| Final Pump Resistance | .192 | .217 | NS |
| Glomerulosclerosis % | 4.14 | 7.54 | NS |
Patient and death-censored graft survival curves were not statistically different. Recipients of DCD kidneys from donors given TPA had a mean one-year post-transplant eGFR of 62.7 [SD: 19.7] compared with recipients of DCD kidneys from donors not given TPA who had a mean one-year post-transplant eGFR of 54.9 [SD 18.4]. This difference (figure 1) was not significant (p=0.1943). The incidence of post-transplant hematomas documented as a surgical complication was 14.3% in the TPA group vs 0% in the non-TPA group (p=NS).
*Conclusions: The use of TPA in DCD donors did not appear to adversely impact outcomes of recipients. Of note, the samples were not fully randomized, as donors not suitable for placement of the liver all were in the non-TPA group. The incidence of hematomas, while not significant, warrants further study in a larger sample
To cite this abstract in AMA style:
Shipman E, Faria WDe, Preczewski L, Vianna R, Guerra G. Recipient Outcomes of DCD Kidneys with and without Donor TPA Administration [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/recipient-outcomes-of-dcd-kidneys-with-and-without-donor-tpa-administration/. Accessed October 29, 2020.« Back to 2020 American Transplant Congress