FP849KIDNEY TRANSPLANTATION WITH ORGANS FROM CONTROLLED DONORS AFTER CIRCULATORY DEATH: EARLY REPORT FROM SPANISH MULTICENTRE EXPERIENCE

Abstract

Introduction and Aims: Controlled donors after cardiac death (cDCD) programs have evolved in several countries around the world. Spain has a long experience on uncontrolled DCD but started to develop cDCD programs from 2011. The aim of GEODAS (Study group for cDCD by its Spanish initials) is to gather experience, describe the follow-up, identify prognostic factors and contribute to development and promotion of cDCD. Methods: Design: Prospective cooperative study on 11 centres with cDCD programs. Intervention: Kidney transplant (Tx) from cDCD, Immunosuppressive induction regimen mainly with Tymoglobulin or Basiliximab (72.6/27.3%) plus prednisone, MFM tacrolimus (90.3%) or mTOR-inhibitor (9.6%). Main variable: Best eGF after one year. Preliminary analysis of 139 patients with a mean follow-up of 1 year. Results: Seventy-eight donors (53.6 y, 67.8% male, 74.6% CV death). Five kidneys were discarded ( pairs currently functioning) and 151 grafted. Twelve went to other centres and 139 (age: 53.7 y; 70.5% male) were included in this study. 87.8% 1st Tx; 2.9% pre-emptive; 79.7% from HD; 17.3% from PD; dialysis vintage 2.6 y; 20.3% with diabetes and 10.8% with a previous CV event. None of receptors presents PRA > 90%. Cold ischemia time was 11.9 h and mean HLA-missmatches was 3.8 over 6. Renal function: Six primary non-functioning (PNF) (5 vascular/1 urologic) with their grafts-pairs properly functioning. PNF had longer cold ischemia time (18.8 vs 11.7; p= 0.03). Delayed graft function rate was 43.4% . Acute rejection rate: none from 0-3 months and 5 from 3-12 months. Nadir Cr 1.4 mg/dL (range 0.6-3.2) and best eGFR 58.11 (24.12) ml/min. Serum Cr and urine Alb/Cr ratio: (mg/dl/ mg/g): 2.1 /72.3; 1.7/ 61.8; 1.6/100; 1.6/194 at1, 3, 12 and 24 months respectively. Death-censored graft survival was 97 % (12 months) and 93.8% (24 months)). Multivariate model for factors associated with eGFR > 50 ml/min previous RRT (HD vs DP): OR=3.1; donor age < 54: OR 1,8. effect. However, cold ischemia time (OR 1.04 per hour]) and donor age (OR 1.063 per year [0.99-1.13]) showed relevant trends but not significant effect. Patient survival: 4 deaths with functioning graft due to sudden death, aorta dissection and sepsis (2 patients). Patient survival rate at 24 months was 95.8%. Conclusions: These results are similar to brain-death donor Tx reported in literature, especially for the graft and recipient survival. Acute rejection rate was extremely low. Pretransplant PD as the mode of RRT and donor age <54 yr-old are associated with better graft function at one year. Shortening cold ischemia time could also improve the results and avoid primary non-functioning kidneys. cDCD programs are easier and more efficient than uncontrolled DCD programs with a higher rate of graft viability and a good-enough results to promote them.