Early outcomes of kidney transplantation from elderly donors after circulatory death (GEODAS study)

BMC Nephrology

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[1] 0000 0000 8970 9163, grid.81821.32, H.U. de la Paz, Madrid, Spain;0000 0001 0277 7938, grid.410526.4, HGU Gregorio Marañón, Madrid, Spain;0000 0001 0675 8654, grid.411083.f, H. Vall d’Hebron, Barcelona, Spain;C.H.U de A Coruña, A Coruña, Spain;C.U de Navarra, Pamplona, Spain;F. Jiménez Díaz, Madrid, Spain;H. Bellvitge, Barcelona, Spain;H. Clinic de Barcelona, Barcelona, Spain;H. German Trias y Pujol, Barcelona, Spain;H.U. Carlos Haya, Malaga, Spain;H.U. Cruces, Bilbao, Spain;H.U. Dr Peset, Valencia, Spain;H.U. La Fe, Valencia, Spain;H.U. Marqués de Valdecilla, Santander, Spain;H.U. Puerta del Mar, Cádiz, Spain;H.U. Reina Sofia, Córdoba, Spain;H.U. de Albacete, Albacete, Spain;Nephrology & Transplant Department, University Hospital Puerta de Hierro, Universidad Autónoma Madrid, Public Research Net RedInRen ISCIII 016/009, C/Manuel de Falla s/n, 28222, Majadahonda, Madrid, Spain;grid.7080.f, Nephrology Department and Kidney Transplantation Program, Hospital del Mar, Parc de Salut Mar, Universitat Autónoma Barcelona and Universitat Pompeu Fabra, Nephropaties Research Group Institute Mar for Medical Research, Passeig Maritim 25-29, 08003, Barcelona, Spain;

关键词: Kidney transplantation;    Elderly donors;    Donors after circulatory death;    Clinical outcomes;    Delayed graft function;   

DOI  :  10.1186/s12882-019-1412-0

来源: publisher

【 摘 要 】

BackgroundSpain has dramatically increased the number of controlled circulatory death donors (cDCD). The initial selection criteria for considering cDCD for kidney transplantation (KT) have been expanded progressively, with practically no limits in donor age during the last years. We aimed to analyze the early clinical outcomes using expanded (> 65 years) cDCD in comparison with standard ones.MethodsObservational multicenter study including 19 transplant centers in Spain. We performed a systematic inclusion in a central database of every KT from expanded cDCD at each participant unit from January-2012 to January-2017. Surgical procedures and immunosuppressive protocols were based on local practices. Data was analyzed in the central office using logistic and Cox regression or competitive-risk models for multivariate analysis. Median time of follow-up was 18.1 months.Results561 KT were performed with kidneys from cDCD, 135 from donors older than 65 years. As expected, recipients from older cDCD were also older (65.8 (SD 8.8) vs 53.7 (SD 11.4) years; p < 0.001) and with higher comorbidity. At 1 year, no differences were found amongst older and younger cDCD KT recipients in terms of serum creatinine (1.6 (SD 0.7) vs 1.5 (SD 0.8) mg/dl; p = 0.29). Non-death censored graft survival was inferior, but death-censored graft survival was not different (95.5 vs 98.2% respectively; p = 0.481). They also presented a trend towards higher delayed graft function (55.4 vs 46.7%; p = 0.09) but a similar rate of primary non-function (3.7 vs 3.1%; p = 0.71), and acute rejection (3.0 vs 6.3%; p = 0.135). In the multivariate analysis, in short follow-up, donor age was not related with worse survival or poor kidney function (eGFR < 30 ml/min).ConclusionsThe use of kidneys from expanded cDCD is increasing for older and comorbid patients. Short-term graft outcomes are similar for expanded and standard cDCD, so they constitute a good-enough source of kidneys to improve the options of KT wait-listed patients.

【 授权许可】

CC BY