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

• Main Authors: María José Pérez-Sáez, Omar Lafuente Covarrubias, Domingo Hernández, Francesc Moreso, Edoardo Melilli, Javier Juega, Erika de Sousa, Paula López-Sánchez, María Luisa Rodríguez-Ferrero, Naroa Maruri-Kareaga, María Dolores Navarro, Rosalía Valero, María Auxiliadora Mazuecos, Francisco Llamas, Paloma Martín-Moreno, Antón Fernández-García, Jordi Espí, Carlos Jiménez, Ana Ramos, Eva Gavela, Julio Pascual, Jose M. Portolés, on behalf of the GEODAS Group
• Format: Article
• Language: English
• Published: BMC 2019-06-01
• Series: BMC Nephrology
• Subjects: Kidney transplantation; Elderly donors; Donors after circulatory death; Clinical outcomes; Delayed graft function
• Online Access: http://link.springer.com/article/10.1186/s12882-019-1412-0

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.