SP670CONTROLLED CARDIAC DEATH DONOR (CDCD) STRATEGY FOR KIDNEY TRANSPLANTATION. SPANISH MULTICENTER EXPERIENCE AFTER TWO YEARS OF FOLLOW-UP. SENTRA-GEODAS-GROUP

Abstract

Introduction and Aims: Controlled donation after cardiac death (cDCD) programs are running in several countries for years. National transplant organization (ONT) has developed a nationwide program in Spain from 2012 and 40 Centers had started by Aug 2015 (415 cDCD Kidney transplants-KTx from Jan-2012 to Aug-2015). Fourteen centers have joined this study group. We present our preliminary analysis of clinical outcomes. Methods: Observational prospective multicentre study. Systematic inclusion of every KTx from cDCD at joined units. Local center surgical procedures and IS protocols. Results: We included 246 cDCD KTx from 139 donors: 57.1 years, 64.8% male who died mainly due to CV causes, sCr 0.7mg/dl. Seven kidneys were discharged for several reasons and 19 transferred and implanted in other centers. 246 recipients: 54.9y, 69.3% males 78.2% from hemodialysis, 17,3% peritoneal, 8.8% preemptive; 89.5% first KTx, 9.7% 2nd, 0.8% 3rd. Cold ischemia time (CIT): 11h; median warm IT 24min, HLA-mismatch: 4 [0-5]. Immunosuppression: 98.8% induction (Thymoglobulin 67.3%/Basiliximab 31.5%) plus prednisone-MMF-Tacrolimus (83.1%) or mTOR (6.9%). Mean follow-up: 14 [3-48] monthsGraft Function: Primary graft failure (PGF): 3%, delayed graft function (DGF): 47.8%, Nadir Cr: 1.3 mg/dl [0,6-3,1]. Best eGFR (MDRD-4) 54.9 (23.4) ml/min. 1st year serum Cr 1.6 [0.9 - 4.8] 2nd year Cr 1.5 mg/dl [0.7- 4.9]. Final end-points: 8 patients died with functioning graft (6 CV, 2 sepsis). 14 graft failures with return to dialysis In the univarate analysis the probability to reach 1st year eGFR >;50 ml/min after the first cDCD KTx was associated to a lower donor age (OR 1,1 per year) a shorter CIT (1,04 per hour) immediate function (4,2) or type of induction (Thymoglobulin vs Basiliximab OR 2,9) but not to HLA mismatches, previous dialysis or recipient age. Conclusions: KTx with cDCD present higher DGF than historic reference for brain death donor but similar PGF rate and patient or graft survival rates. Our results aim us to promote this cDCD all over the country.