SP717ANALYSIS OF DONOR-RECIPIENT MATCHING IN SIMULTANEOUS PANCREAS-KIDNEY TRANSPLANTATION

Abstract

INTRODUCTION AND AIMS: Simultaneous pancreas-kidney transplant (SPKT) has become the therapy of choice for type 1 diabetic patients with end-stage renal disease. Our analysis examines the results of the current policy for pancreas-kidney allocation in Portugal. The study population was obtained from patients enrolled at our center, with only other existing center in the country. METHODS: Retrospective analysis of all SKPT patients at our transplant center. Continuous variables were presented as means or medians, according to normality; and categorical variables presented as frequencies. For calculation of the KDRI and KDPI scores, we used the calculator available on the OPTN website pertaining to all kidney donors recovers in 2016 in the United States (USA). RESULTS: We included 72 recipients, 64% male, with a mean age of 37+/-7 years, a median time of T1DM of 25.5 years, mean body mass index was 23. Donor's mean age was 34+/-8 years (8-51 years), mean BMI 23.5. Most recipients received organs from donors with similar BMI, with only 8 recipients receiving organs from donors whose BMI was > 3 Kg/m2 lower than their own. Donors death cause was primarily due to stroke (65%); other causes included head trauma (29.2%), anoxia (4.3%), and others (1.5%). Donors past medical history included hypertension (14%) but did not include history of diabetes. Distribution of donor-recipient pair by blood group as follows: Receivers and Donors 0 50%; A 40%; B 8.8%; AB 1.2%. Mean cold ischemia time for pancreas was 6.4h (3.3-16h) and for kidney was 8.8h (5-17h).Recipients were favourably allocated age-matched donors with only 8 recipients receiving organs from donors aged more 15 years. Conversely, 15 recipients received organs from donors 15 years younger than themselves. Over 76% of recipients received a kidney scored with a KDRI<1, meaning that these grafts have a lower risk of failure than the graft of the median donor of the USA in 2016.Over 33% our recipientes were pre-sensitized with a Panel Reactive Antibody (PRA) >0%. For sensitized patients mean PRA was 7% (1-98%). Pre-formed donor specific antibodies were identified in 8 patients before transplantation. The HLA matching between donor and recipient obtained was as follows: 0 mismatch (MM) 2.9%; 1MM 4.4%; 2MM 2.9%; 3MM 14.7%; 4MM 33.8%; 5MM 26.4%; 6MM14.7%.The mean follow-up time of patients was 31 months, with 4 deaths (3 during immediate post-transplant, and one at 4 months) with median graft survival of 28 months for kidney and 24 months for pancreas. Currently, 94% of patients are alive, 95.6% have a functioning kidney and 86.7% have a functioning pancreas. CONCLUSIONS: The current allocation policy for SKPT recipients provides good quality organs. Our follow-up of was limited. Further studies are warranted to evaluate the effects of donor-recipient match on patient and graft rates.