Should Kidney Retransplants Be Performed From Either Extended Criteria Donor Or Donation After Cardio Circulatory Death Donors?
Wake Forest Baptist Medical Center, Winston-Salem, NC
Meeting: 2019 American Transplant Congress
Abstract number: A205
Keywords: Donors, marginal, Kidney transplantation, Sensitization
Session Information
Session Name: Poster Session A: Kidney Deceased Donor Allocation
Session Type: Poster Session
Date: Saturday, June 1, 2019
Session Time: 5:30pm-7:30pm
Presentation Time: 5:30pm-7:30pm
Location: Hall C & D
*Purpose: Donation after brain death expanded criteria donors (ECD) and donation after cardiocirculatory death (DCD) standard criteria donors (DCD/SCD) increase the donor organ pool but the value of using these kidneys for kidney retransplant (KRTx) has been questioned because of higher rates of delayed graft function (DGF) and lower expected long-term survival outcomes. The study purpose was to analyze our single center experience with recipients of kidneys from either ECD or DCD/SCDs stratified by primary kidney transplant (KT) vs KRTx.
*Methods: Single center retrospective review of all ECD and DCD/SCD KT recipients. Standardized management algorithms were used to preserve nephron function (including machine preservation) and all patients (pts) received depleting antibody induction with FK/MPA/± prednisone.
*Results: Over a 13-year period, we performed 560 ECD KTs (530 primary and 30 KRTxs) and 289 DCD/SCD KTs (252 primary and 37 KRTxs). Donor and recipient characteristics were similar between primary and KRTxs in each group except for sensitization rate (PRA ≥20%; 6% ECD primary vs 27% KRTX, 15% primary vs 51% KRTx in DCD/SCD, both p<0.01). With mean follow-up of 5 years, actual pt survival (PS), kidney graft survival (GS), death-censored kidney GS (DCGS), DGF, and primary non-function (PNF) for ECD primary vs ECD KRTx were 67 vs 60% (NS), 52 vs 43% (NS), 65 vs 62% (NS), 26 vs 23% (NS), and 5 vs 7% (NS), respectively. In the DCD/SCD group, actual PS, GS, DCGS, DGF, and PNF for DCD/SCD primary vs DCD/SCD KRTx were 85 vs 78% (NS), 68 vs 65% (NS), 75 vs 71% (NS), 53 vs 62% (NS), and 4 vs 14% (p=0.03), respectively.
*Conclusions: Compared to primary KT, survival rates following KRTx are slightly lower but still acceptable with either ECD or DCD/SCD kidneys. Mid-term KRTx outcomes are better with DCD/SCD compared to ECD kidneys even though DCD/SCD KRTxs have a higher incidence of DGF and PNF. Because KRTx pts represent an inherently higher immunological risk group with longer waiting times, we advocate transplantation of appropriately selected ECD or DCD/SCD kidneys for these pts.
To cite this abstract in AMA style:
Harriman D, Gurram V, Farney A, Rogers J, Orlando G, Jay C, Reeves-Daniel A, Mena-Gutierrez A, Gautreaux M, Doares W, Kaczmorski S, Stratta R. Should Kidney Retransplants Be Performed From Either Extended Criteria Donor Or Donation After Cardio Circulatory Death Donors? [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/should-kidney-retransplants-be-performed-from-either-extended-criteria-donor-or-donation-after-cardio-circulatory-death-donors/. Accessed May 18, 2025.« Back to 2019 American Transplant Congress