SP712RISK PREDICTION MODEL FOR DELAYED GRAFT FUNCTION IN A COHORT OF BRAZILIAN KIDNEY TRANSPLANTATION FROM DECEASED DONORS: WHAT YOU SEE IS NOT WHAT YOU GET!

Abstract

INTRODUCTION AND AIMS: The estimated frequency of delayed graft function (DGF) in Brazil ranges from 50 to 70%, despite deceased donor and recipient characteristics similar to those reported in USA and Europe. To date, no study has evaluated the risk factors for this high DGF rate. It is speculated that this is due to the suboptimal maintenance care of potential donors before organ retrieval. METHODS: This study prospectively evaluated the expected (according to DGF calculator, available on www.transplantcalculator.com) and the observed incidence of DGF in 443 deceased kidney transplants (KT) performed in two Brazilian centers between Jan 2015 and Dec 2017. Both centers are located in a region with high-performance organ procurement, a small KT waiting list, and with locally predominant use of ideal donors. Recipients under 16yo and machine perfused kidneys were excluded. Risk factors for DGF were evaluated in a multivariable analysis. DGF was defined as the need for dialysis in the first week after transplantation. RESULTS: KT patients were predominantly men (57%), young (44615yo), overweight (BMI 2464kg/m2), mixed race (84%), with unknown etiology of CKD (30%) and 47648 months on dialysis. Retransplants were 8%, with PRA of 12624%, and 6% presented DSA. Donors were predominantly young (31613yo), slightly overweight (BMI 2562kg/m2), non-hypertensive (89%), with a good terminal serum creatinine (1.260.6mg/dL), who died due to cranial trauma (70%), and 90% were standard criteria donors. 15% had reversed cardiac arrest and 96% in use of vasoactive drugs. Mean serum Na+ and CPK were 160618mEq/L and 2,5476257 UI/L, respectively. All donors were brain dead (DBD) and cold ischemia time (CIT) was 2165h. The estimated DGF was 16% and the observed DGF was 53%. In multivariable analysis, risk factors for DGF was time on dialysis (OR 1.025, 95%CI 1.007-1.043, p=0.006), CIT (OR 1.205, 95%CI 1.049-1.382, p=0.008), donor BMI (OR 1.231, 95% CI 1.013-1.497, p=0.037), and donor CPK (OR 1.000, 95%CI 1.000-1.001, p=0.039). CONCLUSIONS: The observed incidence of DGF in this cohort of KT from ideal deceased donors was 3-fold higher than the expected. In addition to the traditional risk factors, such as time on dialysis, BMI and CIT, donor CPK was independently associated with DGF, suggesting the important role of donor hemodynamic conditions.