Abstract: FR-PO1021
Predicting Expanded Criteria Donor Transplant Outcomes
Session Information
- Transplantation: Donor-Candidate Assessment and Predictors of Outcome
November 03, 2017 | Location: Hall H, Morial Convention Center
Abstract Time: 10:00 AM - 10:00 AM
Category: Transplantation
- 1702 Transplantation: Clinical and Translational
Authors
- Sapir-Pichhadze, Ruth, McGill University, Montreal, Quebec, Canada
- Tchervenkov, Jean, McGill Unversity Health Center, Montreal, Alberta, Canada
- Rabin, Carly, Royal College of Surgeons in Ireland (RCSI), Montreal, Quebec, Canada
- Baran, Dana, Royal Victoria Hospital, Montreal, Quebec, Canada
- Morein, Justin, McGill University, Montreal, Quebec, Canada
- Saha chaudhuri, Paramita, McGill University, Montreal, Quebec, Canada
Background
Decisions on expanded criteria donor (ECD) organ utilization or discard rely primarily on selected clinical and histological features of ECD grafts. We sought to identify which of the donor, recipient, and transplant characteristics are most predictive of long-term ECD transplant outcomes.
Methods
We conducted a retrospective cohort study in first time ECD kidney transplant recipients (KTR) transplanted between January 1, 2008 and December 31, 2014 at a Canadian Centre. The value of baseline donor (kidney donor risk index (KDRI), eGFR, and histology on frozen sections of procurement biopsies), recipient (age, sex, and cause of ESRD) and transplant (HLA mismatch, pulsatile perfusion, cold ischemia time, induction therapy, maintenance immunosuppression, and delayed graft function (DGF)) characteristics in predicting all-cause graft failure, defined as return to dialysis, re-transplantation, and death with function, was evaluated in univariate Cox proportional hazards models. Given the small sample size, variables that were statistically significant at level = 0.1 in the univariate analysis were considered for inclusion in multivariable models. In addition to baseline characteristics, a multivariable model including time-varying post-transplant eGFR measured at 3-months intervals was also fit. For the multivariable Cox proportional hazards models, p-value <0.05 was considered statistically significant.
Results
A total of 163 first-time ECD KTR with a median post-transplant follow-up of 3 years were included. Of the baseline donor, recipient and transplant characteristics, recipient age, cause of ESRD, and DGF were statistically significantly associated with all-cause graft loss in univariate analyses (p-value of likelihood ratio test 0.04, 0.07, and 0.01, respectively). In the time-fixed and time-varying multivariable Cox proportional hazards models, only recipient age (hazard ratio (HR) 1.04 [95% confidence interval (CI): 1.00, 1.09]; p-value=0.06) and time-varying eGFR (HR 0.96 [95%CI: 0.94, 0.98]; p-value=0.001), respectively, were independently associated with all-cause graft loss. C-indeces were 0.62 and 0.696 (SE=0.05), respectively.
Conclusion
In our study, recipient age and post-transplant eGFR were most predictive of ECD transplant outcomes. Caution should be exercised when considering organ discard based on ECD donor characteristics alone.