Single Kidney Transplantation from DCD Maastricht Category 3 Donors ≥ 60 Years: Is It Safe?
1Renal Transplant, Ospedale Maggiore Policlinico, Milan, Italy
2Renal Transplantation, The Royal London Hospital, London, United Kingdom
3Organ Transplant, Presidio Ospedaliero S. Salvatore, L'Aquila, Italy
Meeting: 2017 American Transplant Congress
Abstract number: 329
Keywords: Donors, Elderly patients, Kidney transplantation, non-heart-beating, Outcome
Session Information
Session Name: Concurrent Session: Donors with Acute Kidney Injury
Session Type: Concurrent Session
Date: Monday, May 1, 2017
Session Time: 4:30pm-6:00pm
Presentation Time: 5:30pm-5:42pm
Location: E450a
Aim. Compared to DBD, DCD kidneys show higher rates of primary non function (PNF), DGF, rejection, and premature transplant (Tx) loss. Some authors have advised against the use of elderly DCD kidneys but available data are conflicting. We assessed outcomes of single kidney Tx from DCD Maastricht category 3 donors ≥ 60 years.
Methods. In this single centre prospective study we enrolled patients who received first kidney Tx from a DCD Maastricht category 3 donor. All the organs were preserved on ice and all the recipients were given the same immunusuppression. Patients were allocated to two groups: YOUNG (donor < 60 years) or OLD (donor ≥ 60 years). Outcomes were prospectively recorded and compared between groups at 3 years of follow up.
Results. Baseline characteristics are detailed in the table:
| YOUNG | OLD | P | |
| Patients (#) | 73 | 40 | – |
| Male/Female | 42/31 | 22/18 | ns |
| Caucasian ethnicity (%) | 36 | 40 | ns |
| Primary transplantation (%) | 100 | 100 | ns |
| Recipient age (years) | 47±11 | 58±8 | <0.05 |
| Donor age (years) | 40.5±12 | 66±5 | <0.05 |
| HLA mismatch (#) | 3.4±1 | 3.7±1 | ns |
| Cold ischemia time (hours) | 15±5 | 15±4.5 | ns |
| Anti-thymocyte globulins induction (%) | 81 | 72.5 | ns |
| Cyclosporine-MMF-steroid maintenance (%) | 100 | 100 | ns |
| Follow up (years) | 3.6±1.9 | 3.4±2 | ns |
After 3 years, patients in OLD showed significantly lower patient survival (69 vs 88%, P<0.05), death-censored graft survival (69 vs 88%, P<0.05), and MDRD GFR (36±5 vs 49±6 mL/min, P<0.05) compared to recipients in YOUNG. The incidence of DGF and renal vein thrombosis was significantly higher in OLD: 70 vs 47% (P<0.05) and 10 vs 0% (P<0.05), respectively. Cumulative rejection (YOUNG: 18 vs OLD: 12.5%), NODAT, Polyomavirus-associated nephropathy, and PTLD were similar (P=ns).
Conclusions. Single kidney Tx from DCD Maastricht category 3 donors ≥ 60 years are at increased risk of early graft loss and offer inferior graft function compared to transplants from younger donors. Higher incidence of peri-operative complications such as graft thrombosis and DGF should be expected with increased post-transplant mortality.
CITATION INFORMATION: Favi E, Puliatti C, Ferraresso M, Iesari S, Cacciola R. Single Kidney Transplantation from DCD Maastricht Category 3 Donors ≥ 60 Years: Is It Safe? Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Favi E, Puliatti C, Ferraresso M, Iesari S, Cacciola R. Single Kidney Transplantation from DCD Maastricht Category 3 Donors ≥ 60 Years: Is It Safe? [abstract]. Am J Transplant. 2017; 17 (suppl 3). https://atcmeetingabstracts.com/abstract/single-kidney-transplantation-from-dcd-maastricht-category-3-donors-60-years-is-it-safe/. Accessed November 21, 2024.« Back to 2017 American Transplant Congress