Kidney transplant from controlled donors following circulatory death: Results from the GEODAS-3 multicentre study

Data de publicació: 01/03/2019

Autors de IIS La Fe

Jordi Espí Reig

Autor
Marta De La Rubia Navarro

Autor

Autors aliens a IIS La Fe

Portoles, JM
Perez-Saez, MJ
Lopez-Sanchez, P
Lafuente-Covarrubias, O
Juega, J
Hernandez, D
Mazuecos, MA
Rodriguez-Ferrero, ML
Maruri-Kareaga, N
Moreso, F
Melilli, E
de Souza, E
Ruiz, JC
Llamas, F
Gutierrez-Dalmau, A
Guirado, L
Martin-Moreno, P
Flores, IP
Fernandez-Garcia, A
Jimenez, C
Gavela, E
Ramos, A
Pascual, J
Grp GEODAS

Abstract

Introduction: Many European countries have transplant programmes with controlled donors after cardiac death (cDCD). Twenty-two centres are part of GEODAS group. We analysed clinical results from a nephrological perspective. Methods: Observational, retrospective and multicentre study with systematic inclusion of all kidney transplant recipients from cDCD, following local protocols regarding extraction and immunosuppression. Results: A total of 335 cDCD donors (mean age 57.2 years) whose deaths were mainly due to cardiovascular events were included. Finally, 566 recipients (mean age 56.5 years; 91.9% first kidney transplant) were analysed with a median of follow-up of 1.9 years. Induction therapy was almost universal (thymoglobulin 67.4%; simulect 32.8%) with maintenance with prednisone-MMF-tacrolimus (91.3%) or combinations with mTOR (6.5%). Mean cold ischaemia time (CIT) was 12.3 h. Approximately 3.4% (n=19) of recipients experienced primary non-function, essentially associated with CIT (only CIT >= 14 h was associated with primary non-function). Delayed graft function (DGF) was 48.8%. DGF risk factors were CIT >= 14 h OR 1.6, previous haemodialysis (vs. peritoneal dialysis) OR 2.1 and donor age OR 1.01 (per year). Twenty-one patients (3.7%) died with a functioning graft, with a recipient and death censored graft survival at 2-years of 95% and 95.1%, respectively. The estimated glomerular filtration rate at one year of follow-up was 60.9 ml/min. CIT is a modifiable factor for improving the incidence of primary non-function in kidney transplant arising from cDCD. cDCD kidney transplant recipients have higher delayed graft function rate, but the same patient and graft survival compared to brain-dead donation in historical references. These results are convincing enough to continue fostering this type of donation. (C) 2018 Sociedad Espanola de Nefrologia. Published by Elsevier Espana, S.L.U.

Dades de la publicació

ISSN/ISSNe:: 0211-6995, 1989-2284
Tipus:: Article
Pàgines:: 151-159
DOI:: 10.1016/j.nefro.2018.07.013
PubMed:: 30497696
Factor d'Impacte:: 0,362 SCImago ℠
Quartil:: Q3 SCImago ℠

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Keywords

Kidney transplant; Donation with controlled donors; after circulatory death; Clinical outcomes; Delayed graft function

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