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Kidney Week

Abstract: PO2058

Elderly Kidney Transplantation Donors After Circulatory Death: Is It Worth It?

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Frías González, Aida, Hospital Universitario 12 de Octubre, Madrid, Comunidad de Madrid, Spain
  • Gonzalez monte, Esther, Hospital Universitario 12 de Octubre, Madrid, Comunidad de Madrid, Spain
  • Andres, Amado, Hospital Universitario 12 de Octubre, Madrid, Comunidad de Madrid, Spain
Background

Kidney transplantation (KT) remains the treatment of choice for end-stage renal disease, since it offers better outcomes and quality of life and is less costly in the long run compared with stay on dialysis. In order to expand the donor pool, donation after circulatory death (DCD) has become an increasingly popular strategy, and eligibility criteria for this procedure have widened in the last few years.

Methods

Single-center retrospective study in which we described the clinical characteristics and outcomes of all the patients who underwent Maastricht category-III (controlled) DCD (cDCD) KT from January 2006 to October 2019. IBM SPSS (v25.0) was used for all the statistical analysis. Two-sided p values of <0.05 were considered statistically significant.

Results

We performed 54 cDCD KT, median follow-up was 36 (0.5-155) months. Donors’ mean age was 50.2 years (range 19-81), 20.4% were ≥70 years, 64.8% male, 22.2% diabetics, 25,9% suffered hypertension.
24 (44.5%) recipients presented delayed graft function and 6 (11.1%) suffered primary nonfunction, with no differences depending on donor age (≥ or <70 years). Primary nonfunction was the main cause of graft loss, which occurred in 8 patients (14.8%), and it was significantly higher in donors ≥70 years old (p=0.021).
In the multivariant analysis only donor age ≥70 years was related to graft loss. Other factors examined such as cold ischemia time >14 hours, warm ischemia time >17 minutes and the presence of cardiovascular disease, didn’t show statistically significant differences.
At one-year follow-up, renal function was significantly better in donors <70 years compared to donors ≥70 years, with mean serum creatinine 1.4 vs 2.1 mg/dl respectively (p=0.003), and estimated filtration rate 36.4 ± 19 vs 57.9 ± 18.9 ml/min per 1.73 m2 (p=0.008).
The mortality rate was higher among recipients from older donors (3 [23.7%] vs 2 [4.6%], p=0.021).

Conclusion

cDCD KT donors ≥70 years have inferior outcomes than KT from donors <70 years concerning graft loss, overall survival and renal function 12 months after transplantation. Therefore, it is essential to evaluate cautiously whether or not to proceed with this transplants.