EPIDEMIOLOGY AND CLINICAL OUTCOMES II

J.K. Pine, P.J. Goldsmith, D.M. Ridgway, J. Barwick, R. Baker, C. Newstead, S. Pollard, K.V. Menon, N. Ahmad, M. Attia
Organ Transplantation, St James's University Hospital, Leeds/UNITED KINGDOM

Body: Introduction. Renal grafts procured from donors after cardiac death (DCD) have increased rates of delayed graft function compared to those procured from conventional donation after brain death donors (DBD). However, patient and graft survival are comparable between DCD and DBD grafts. It is a practice in our centre to attempt to age match recipients were possible when using grafts from DCD donors DCD in an attempt not to give kidneys from older DCD donors to young recipients. This study seeks to identify the impact of age matching on graft and recipient outcomes in DCD donor kidney transplant. Methods. Donor and recipient ages were prospectively recorded to allow matching of donor and recipients for DCD transplantation. Donor:recipient age ratios were calculated and the cohort of well matched donor-recipient pairs (i.e.lying between the 25^th and 75^th centiles) were compared with less favourably matched donor-recipient pairs (i.e. <25^th centile or >75^th centile). Rates of DGF, primary non function (PNF), acute rejection (AR), 5 year graft and patient survival and estimated GFR were compared. Categorical data were compared using Χ² or Fishers exact test; longitudinal data were compared using a Student t test; all at a 5% level of statistical significance. Results. In the study period between 2002-2009, 201 renal transplants were performed using DCD donors, all were analysed. 99 were performed between donors and recipients matched for age. Grafts matched for age had rates of AR (14% vs 20%; Χ²=1.20; p=0.27), DGF (58% vs 49%; Χ²=1.52; p=0.22) and PNF (5% vs 3%; Χ²=0.36; p=0.55) comparable to less well matched grafts. Five year recipient (95% vs 85%;Χ²=0.122; p=0.05) and graft survival (84% vs 89%; Χ²=1.835; p=0.18) was similarly comparable. Though there was a significant difference in GFR between groups at 1 year (49 vs 65ml/min; t=-3.3; p=0.001) this was not apparent by 3 or 5 years (48 vs 57 ml/min; t=-1.8; p=0.07 and 51 vs 58 ml/min; t=-0.72; p=0.48). Conclusions. The matching of DCD donors to recipients by age has no impact on rates of AR or PNF. Similarly there is no effect on medium term graft function or recipient and graft survival. The use of donor age to select a matched recipient for a DCD graft is not a useful determinant of most graft and recipient outcomes.

Disclosure: All authors have declared no conflicts of interest.