MOLECULAR MECHANISMS OF DELAYED KIDNEY GRAFT FUNCTION

S. Teraoka¹, A. Aikawa², K. Takahashi³, K. Uchida⁴, S. Satomi⁵, S. Takahara⁶, S. Oshima⁷, J. Ashikari⁸, K. Nomoto^9
1Kidney Center, Department Of Surgery, Tokyo Women's Medical University, Tokyo/JAPAN, ²Nephrology, Toho University, Tokyo/JAPAN, ³, Niigata University, School of Medicine, Niigata/JAPAN, ⁴, Nagoya Daini Red Cross Hospital, Nagoya/JAPAN, ⁵Transplantation, Reconstruction And Endoscopic Surgery, Tohoku University, Sendai/JAPAN, ⁶Department Of Advanced Technology For Transplantation, Osaka University, Graduate School of Medicine, Suita/JAPAN, ⁷, National Center for Geriatrics and Gerontology, Aichi/JAPAN, ⁸, Japan Organ Transplant Network, Tokyo/JAPAN, ⁹, Japn Organ Transplant Network, Tokyo/JAPAN

Body: Introduction: Recently the donor criteria is expanding so as to overcome the organ shortage. Kidney transplants (KTx) from non-heart-beating decased donor (NHBDD) are one of options despite the increasing risk of non-function kidney (NFK). Methosd: Causative factors of NFK in 1856 KTx from NHBDD were investigated. The mean age was 46.2±16.8 (1~74) y.o. for donor and 44.8±11.6 (2~72) y.o. for recipient. The mean mismatched number (MMN) of HLA was 0.21±0.44 for DR and 1.46±1.05 for AB. The mean warm ischemic time (WIT) and total IT (TIT) were 8.1±10.6 (0~72) min and 14.1±6.6 (2.5~38.6) hr, respectively. The latest serum creatinine (sCr) of donors was 2.24±2.16 (0.28~16.20). Donor status (age, gender, cause of death, sCr, anuria, hypotension and body temperature), WIT and TIT, catheter insertion for in situ perfusion and discontinuance of ventilator before or after cardiac standstill (CS), preservation solutions, MMN of HLA and immunosuppressants were investigated as causative factors of the incidence of NFK by monovariate and multivariate analyses. All data were collected from 140 institutes by Japan Organ Transplant Network. Results: The NFK occurred in 119 cases out of 1856 (9.1%), and causes of NFK were primary non-function (26), rejection (30), thrombosis (16), death (23) and others. The incidence of NFK was 20.0% for donor age under 5 y.o., 11.4% for donor age over 61 y.o., 21.3% for asphyxia (donor cause of death), and the donor gender, the latest sCr, body temperature and the duration of anuria and hypotension before organ recovery did not influence the incidence of NFK. Canulation and the discontinuance of ventilator before CS reduced the incidence of NFK (7.3% vs 12.9%, 5.0% 10.2%). As for WIT and TIT, the incidence of NFK was 7.8% for less than 5 min, 7.5% for 6-15 min, 9.3% for 16-30 min, 30.8% for over 31 min, 5.5% for less than 12 hr, 11.9% for 12-24 hr and 13.8% for over 24 hr. In the multivariate analysis, the relative risk of NFK was 2.872 (p=0.0107) for donor age over 61 y.o., 5.419 (p=0.0004) for more than 31 min of WIT and 2.025 (p=0.0080) for more than 12 hr of TIT. Conclusion: Donor age, WIT and TIT were the most important contributing factor to NFK in kidney transplatns from NHBDD.

Disclosure: All authors have declared no conflicts of interest.