Kidney transplant from controlled donors following circulatory death: Results from the GEODAS-3 multicentre study
Portolés JM (1), Pérez-Sáez MJ (2), López-Sánchez P (3), Lafuente-Covarrubias O (3), Juega J (4), Hernández D (5), Espí J (6), Navarro MD (7), Mazuecos MA (8), Rodríguez-Ferrero ML (9), Maruri-Kareaga N (10), Moreso F (11), Melilli E (12), de Souza E (13), Ruiz JC (14), Llamas F (15), Gutiérrez-Dalmau A (16), Guirado L (17), Martín-Moreno P (18), Pérez Flores I (19), Fernández-García A (20), Jiménez C (21), Gavela E (22), Ramos A (23), Pascual J (24); en representación del grupo GEODAS.
(1) Hospital Universitario Puerta de Hierro, Madrid, España.
(2) Hospital del Mar, Barcelona, España.
(3) Hospital Universitario Puerta de Hierro, Madrid, España.
(4) Hospital Universitario Germán Trías y Pujol, Barcelona, España.
(5) Hospital Universitario Carlos Haya, Málaga, España.
(6) Hospital Universitario La Fe, Valencia, España.
(7) Hospital Universitario Reina Sofía, Córdoba, España.
(8) Hospital Universitario Puerta del Mar, Cádiz, España.
(9) Hospital General Universitario Gregorio Marañón,, Madrid, España.
(10) Hospital Universitario Cruces, Bilbao, España.
(11) Hospital Universitario de Vall d́Hebron, Barcelona, España.
(12) Hospital Universitario Bellvitge, Barcelona, España.
(13) Hospital Universitario Clinic de Barcelona, Barcelona, España.
(14) Hospital Universitario Marqués de Valdecilla, Santander, España.
(15) Hospital Universitario de Albacete, Albacete, España.
(16) Hospital Universitario Miguel Servet , Zaragoza, España.
(17) Fundación Puigvert, Barcelona, España.
(18) Clínica Universidad de Navarra, Pamplona, España.
(19 Hospital Universitario Clínico San Carlos, Madrid, España.
(20) Complexo Hospitalario Universitario A Coruña, La Coruña, España.
(21) Hospital Universitario de la Paz, Madrid, España.
(22) Hospital Universitario Dr. Peset, Valencia, España.
(23) Fundación Jiménez Díaz, Madrid, España.
(24) Hospital del Mar, Barcelona, España.
Date: Nov 26, 2018Nephrology [SP]
Many European countries have transplant programmes with controlled donors after cardiac death (cDCD). Twenty-two centres are part of GEODAS group. We analysed clinical results from a nephrological perspective.
Observational, retrospective and multicentre study with systematic inclusion of all kidney transplant recipients from cDCD, following local protocols regarding extraction and immunosuppression.
A total of 335 cDCD donors (mean age 57.2 years) whose deaths were mainly due to cardiovascular events were included. Finally, 566 recipients (mean age 56.5 years; 91.9% first kidney transplant) were analysed with a median of follow-up of 1.9 years. Induction therapy was almost universal (thymoglobulin 67.4%; simulect 32.8%) with maintenance with prednisone-MMF-tacrolimus (91.3%) or combinations with mTOR (6.5%). Mean cold ischaemia time (CIT) was 12.3h. Approximately 3.4% (n=19) of recipients experienced primary non-function, essentially associated with CIT (only CIT ≥ 14 h was associated with primary non-function). Delayed graft function (DGF) was 48.8%. DGF risk factors were CIT ≥ 14 h OR 1.6, previous haemodialysis (vs. peritoneal dialysis) OR 2.1 and donor age OR 1.01 (per year). Twenty-one patients (3.7%) died with a functioning graft, with a recipient and death-censored graft survival at 2-years of 95% and 95.1%, respectively. The estimated glomerular filtration rate at one year of follow-up was 60.9 ml/min.
CIT is a modifiable factor for improving the incidence of primary non-function in kidney transplant arising from cDCD. cDCD kidney transplant recipients have higher delayed graft function rate, but the same patient and graft survival compared to brain-dead donation in historical references. These results are convincing enough to continue fostering this type of donation.
CITATION Nefrologia. 2018 Nov 26. pii: S0211-6995(18)30155-3. doi: 10.1016/j.nefro.2018.07.013
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