TY - JOUR
T1 - Early outcomes of kidney transplantation from elderly donors after circulatory death (GEODAS study)
AU - Pérez-Sáez, María José
AU - Lafuente Covarrubias, Omar
AU - Hernández, Domingo
AU - Moreso, Francesc
AU - Melilli, Edoardo
AU - Juega, Javier
AU - De Sousa, Erika
AU - López-Sánchez, Paula
AU - Rodríguez-Ferrero, María Luisa
AU - Maruri-Kareaga, Naroa
AU - Navarro, María Dolores
AU - Valero, Rosalía
AU - Mazuecos, María Auxiliadora
AU - Llamas, Francisco
AU - Martín-Moreno, Paloma
AU - Fernández-García, Antón
AU - Espí, Jordi
AU - Jiménez, Carlos
AU - Ramos, Ana
AU - Gavela, Eva
AU - Pascual, Julio
AU - Portolés, Jose M.
AU - Covarrubias, Omar Lafuente
AU - Sánchez-Sobrino, Beatriz
AU - Santos, Julio Pascual
AU - Zapatero, Ana
AU - Hernández-Marrero, Domingo
AU - Manonelles, Anna
AU - Lauzurica, Ricardo
AU - De Souza, Erika
AU - Diekmann, Fritz
AU - Zárraga, Sofia
AU - Rodríguez-Benot, Alberto
AU - Ruiz, Juan Carlos
AU - Alonso, Ángel
AU - Beneyto, Isabel
AU - López-Oliva, María
AU - Sancho-Calabuig, Asunción
PY - 2019/6/26
Y1 - 2019/6/26
N2 - © 2019 The Author(s). Background: Spain has dramatically increased the number of controlled circulatory death donors (cDCD). The initial selection criteria for considering cDCD for kidney transplantation (KT) have been expanded progressively, with practically no limits in donor age during the last years. We aimed to analyze the early clinical outcomes using expanded (> 65 years) cDCD in comparison with standard ones. Methods: Observational multicenter study including 19 transplant centers in Spain. We performed a systematic inclusion in a central database of every KT from expanded cDCD at each participant unit from January-2012 to January-2017. Surgical procedures and immunosuppressive protocols were based on local practices. Data was analyzed in the central office using logistic and Cox regression or competitive-risk models for multivariate analysis. Median time of follow-up was 18.1 months. Results: 561 KT were performed with kidneys from cDCD, 135 from donors older than 65 years. As expected, recipients from older cDCD were also older (65.8 (SD 8.8) vs 53.7 (SD 11.4) years; p < 0.001) and with higher comorbidity. At 1 year, no differences were found amongst older and younger cDCD KT recipients in terms of serum creatinine (1.6 (SD 0.7) vs 1.5 (SD 0.8) mg/dl; p = 0.29). Non-death censored graft survival was inferior, but death-censored graft survival was not different (95.5 vs 98.2% respectively; p = 0.481). They also presented a trend towards higher delayed graft function (55.4 vs 46.7%; p = 0.09) but a similar rate of primary non-function (3.7 vs 3.1%; p = 0.71), and acute rejection (3.0 vs 6.3%; p = 0.135). In the multivariate analysis, in short follow-up, donor age was not related with worse survival or poor kidney function (eGFR < 30 ml/min). Conclusions: The use of kidneys from expanded cDCD is increasing for older and comorbid patients. Short-term graft outcomes are similar for expanded and standard cDCD, so they constitute a good-enough source of kidneys to improve the options of KT wait-listed patients.
AB - © 2019 The Author(s). Background: Spain has dramatically increased the number of controlled circulatory death donors (cDCD). The initial selection criteria for considering cDCD for kidney transplantation (KT) have been expanded progressively, with practically no limits in donor age during the last years. We aimed to analyze the early clinical outcomes using expanded (> 65 years) cDCD in comparison with standard ones. Methods: Observational multicenter study including 19 transplant centers in Spain. We performed a systematic inclusion in a central database of every KT from expanded cDCD at each participant unit from January-2012 to January-2017. Surgical procedures and immunosuppressive protocols were based on local practices. Data was analyzed in the central office using logistic and Cox regression or competitive-risk models for multivariate analysis. Median time of follow-up was 18.1 months. Results: 561 KT were performed with kidneys from cDCD, 135 from donors older than 65 years. As expected, recipients from older cDCD were also older (65.8 (SD 8.8) vs 53.7 (SD 11.4) years; p < 0.001) and with higher comorbidity. At 1 year, no differences were found amongst older and younger cDCD KT recipients in terms of serum creatinine (1.6 (SD 0.7) vs 1.5 (SD 0.8) mg/dl; p = 0.29). Non-death censored graft survival was inferior, but death-censored graft survival was not different (95.5 vs 98.2% respectively; p = 0.481). They also presented a trend towards higher delayed graft function (55.4 vs 46.7%; p = 0.09) but a similar rate of primary non-function (3.7 vs 3.1%; p = 0.71), and acute rejection (3.0 vs 6.3%; p = 0.135). In the multivariate analysis, in short follow-up, donor age was not related with worse survival or poor kidney function (eGFR < 30 ml/min). Conclusions: The use of kidneys from expanded cDCD is increasing for older and comorbid patients. Short-term graft outcomes are similar for expanded and standard cDCD, so they constitute a good-enough source of kidneys to improve the options of KT wait-listed patients.
KW - Clinical outcomes
KW - Delayed graft function
KW - Donors after circulatory death
KW - Elderly donors
KW - Kidney transplantation
U2 - 10.1186/s12882-019-1412-0
DO - 10.1186/s12882-019-1412-0
M3 - Article
C2 - 31242927
VL - 20
JO - BMC Nephrology
JF - BMC Nephrology
SN - 1471-2369
M1 - 233
ER -