Date: Saturday, May 30, 2020
Session Time: 3:15pm-4:00pm
Presentation Time: 3:30pm-4:00pm
*Purpose: Previous studies have demonstrated comparable rates of graft survival for right and left living donor renal allografts, however such analyses have been conducted among populations wherein the frequency with which right allografts (RA) are used is low, raising the possibility that reported equivalencies are due to careful patient selection; at our institution, the rate of right donor nephrectomy is significantly higher than the national average (36.6% compared to 13.9% per the UNOS database). The purpose of this study is to compare outcomes among patients who underwent living donor renal transplant and received either right or left allografts (LA) at a single, high-volume center wherein rates of RA transplantation exceed reported averages.
*Methods: We performed a retrospective analysis of all living donor renal transplants at a single institution by a single surgeon between July of 2003 and September 19, 2018. Graft survival was the primary endpoint.
*Results: We identified 861 living donor transplants, of which 546 (63%) were LA. In comparing LA and RA transplants, donor and recipient demographics were equivalent. The presence of vascular anomalies was significantly higher among RAs (26.6% of RAs had multiple arteries vs 16.7% of LAs, p = 0.0008; 5.6% of RAs had multiple veins vs 0.4% of LAs, p = <0.0001). Warm ischemia time was slightly longer in transplants involving RAs (33.9 minutes vs 32.4, 95% CI -2.54 to -0.55, p=0.0023). Kaplan Meier analysis demonstrates further that transplants involving LAs and RAs are equivalent with respect to graft survival (p=0.689 log-rank test).
*Conclusions: Despite the fact that transplant of RAs often involves greater technical challenges, long-term outcomes for recipients of such grafts are similar, even at an institution where the utilization of RAs is significantly higher than reported averages.
|Mean recipient age (years)||44.74||43.9||0.489||-1.546 to 3.229|
|Mean Donor age||40.95||41.93||0.213||-0.560 to 2.506|
|Recipient Race||C: 233 AA: 17 Other/unknown: 296||C: 137 AA: 9 Other/unknown: 170||0.447||N/A|
|Donor Race||C: 406 AA: 28 Other/unknow: 112||C: 238 AA: 21 Other/unknown: 57||0.823||N/A|
|Recipient Gender (%)||M: 64.8 F: 35.2||M: 60.7 F: 39.3||0.405||N/A|
|Donor Gender (%)||M: 34.6 F: 65.4||M: 40 F: 60||0.158||N/A|
|Left Graft||Right Graft||p value||95% CI|
|Living related transplant (%)||51.4 (N=280)||52.5 (166)||0.744||N/A|
|Multiple arteries (%)||16.67 (N=80)||26.64 (N=81)||0.0008||N/A|
|Multiple veins (%)||0.4 (N=2)||5.59 (N=17)||<0.0001||N/A|
|Mean cold ischemia time (minutes)||64.83||56.74||0.274||-6.44 to 22.62|
|Mean warm ischemia time (minutes)||32.36||33.9||0.002||-2.54 to -0.55|
To cite this abstract in AMA style:O'Brien DC, Fridell J, Goggins WC. Survival of Right and Left Living Donor Renal Allografts is Equivalent Even with Higher-Than-Average Rates of Right Graft Utilization [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/survival-of-right-and-left-living-donor-renal-allografts-is-equivalent-even-with-higher-than-average-rates-of-right-graft-utilization/. Accessed October 25, 2020.
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