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Observational Study
. 2019 Jun 26;20(1):233.
doi: 10.1186/s12882-019-1412-0.

Early outcomes of kidney transplantation from elderly donors after circulatory death (GEODAS study)

María José Pérez-Sáez  1 , Omar Lafuente Covarrubias  2 , Domingo Hernández  3 , Francesc Moreso  4 , Edoardo Melilli  5 , Javier Juega  6 , Erika de Sousa  7 , Paula López-Sánchez  2 , María Luisa Rodríguez-Ferrero  8 , Naroa Maruri-Kareaga  9 , María Dolores Navarro  10 , Rosalía Valero  11 , María Auxiliadora Mazuecos  12 , Francisco Llamas  13 , Paloma Martín-Moreno  14 , Antón Fernández-García  15 , Jordi Espí  16 , Carlos Jiménez  17 , Ana Ramos  18 , Eva Gavela  19 , Julio Pascual  20 , Jose M Portolés  21 ; GEODAS Group
Collaborators, Affiliations
Observational Study

Early outcomes of kidney transplantation from elderly donors after circulatory death (GEODAS study)

María José Pérez-Sáez et al. BMC Nephrol. .

Abstract

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.

Keywords: Clinical outcomes; Delayed graft function; Donors after circulatory death; Elderly donors; Kidney transplantation.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Kaplan-Meier survival curves between kidney transplant recipients from donors > 65 years and ≤ 65 years. a Patient survival; b Graft survival; c Death-censored graft survival
See this image and copyright information in PMC

References

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