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. 2022 Feb;129(2):225-233.
doi: 10.1111/bju.15509. Epub 2021 Aug 31.

Kidney transplantation from expanded criteria donors: an increased risk of urinary complications - the UriNary Complications Of Renal Transplant (UNyCORT) study

Benoit Mesnard  1 , Maxime Leroy  2 , James Hunter  3 , Delphine Kervella  4   5   6 , Marc-Olivier Timsit  7 , Lionel Badet  8 , Pascal Glemain  1 , Emmanuel Morelon  8 , Fanny Buron  8 , Moglie Le Quintrec-Donnette  9 , Vincent Pernin  9 , Marc Ladriere  10 , Sophie Girerd  10 , Christophe Legendre  7 , Antoine Sicard  11 , Laeticia Albano  11 , Stephane De Vergie  1 , Clarisse Kerleau  4   5   6 , Thomas Prudhomme  12 , Jérôme Rigaud  1 , Diego Cantarovich  4   5   6 , Gilles Blancho  4   5   6 , Georges Karam  1 , Magali Giral  4   5   6 , Simon Ville  4   5   6 , Julien Branchereau  1   3   4   5   6 ; Données Informatisées et VAlidées en Transplantation/Computerized and VAlidated Data in Transplantation (DIVAT) Consortium Affiliations†
Collaborators, Affiliations

Kidney transplantation from expanded criteria donors: an increased risk of urinary complications - the UriNary Complications Of Renal Transplant (UNyCORT) study

Benoit Mesnard et al. BJU Int. 2022 Feb.

Abstract

Objectives: To assess the impact of expanded criteria donors (ECD) on urinary complications in kidney transplantation.

Patients and methods: The UriNary Complications Of Renal Transplant (UNyCORT) is a cohort study based on the French prospective Données Informatisées et VAlidées en Transplantation/Computerized and VAlidated Data in Transplantation (DIVAT) cohort. Data were extracted between 1 January 2002 and 1 January 2018 with 1-year minimum follow-up, in relation to 44 pre- and postoperative variables. ECD status was included according to United Network for Organ Sharing (UNOS) definition. The primary outcome of the UNyCORT study was the association between the donor's ECD/standard criteria donors (SCD) status and urinary complications at 1 year in uni- and multivariate analysis. Sub-group analysis, stratified analysis on ECD/SCD donor's status and transplant failure analysis were then conducted.

Results: Between 1 January 2002 and 1 January 2018, 10 279 kidney transplants in adult recipients were recorded within the DIVAT network. A total of 8559 (83.4%) donors were deceased donors and 1699 (16.6%) were living donors (LD). Among donation after circulatory death (DCD) donors, 224 (2.85%) were uncontrolled DCD and 93 (1.09%) were controlled DCD donors. A total of 3617 (43.9%) deceased donors were ECD. The overall urological complication rate was 16.26%. The donor's ECD status was significantly associated with an increased risk of urological complications at 1 year in multivariate analysis (odds ratio: 1.50, 95% CI 1.31-1.71; P < 0.001) and especially with stenosis and ureteric fistulae at 1 year. There is no association with LD, uncontrolled and controlled DCD. The placement of an endo-ureteric stent was beneficial in preventing urinary complications in all donors and particularly in ECD donors.

Conclusion: The donor's ECD status is associated with a higher likelihood of stenosis and ureteric fistulae at 1 year. Recipients of grafts from ECD donors should probably be considered for closer urological monitoring and systematic preventive measures.

Keywords: donation after circulatory death; expanded criteria donor; kidney transplantation; marginal donors; standard criteria donor; urinary complications.

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References

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