A Single Centre Study of Donation after Cardiac Death Kidney Transplantation - Comparison of Outcomes Between Standard and Expanded Criteria Donor Kidneys: 948

Introduction: Kidneys obtained from donors after cardiac-death (DCD) provide outcomes comparable to those obtained from donors after brain-stem death (DBD). In order to expand the donor pool, more DCD kidneys are being used which were previously considered unacceptable. Here, we compare short-term outcomes within DCD transplants of kidneys from expanded criteria donors (ECD) with those from standard criteria donors (SCD). Methods: From our centre's renal database, we collected data on all controlled (Maastricht 3) DCD kidney transplants from 2004 to 2010. Expanded criteria donor was defined according to UNOS criteria (age ≥ 60 years or 50-59 years with 2 of: hypertension, death from cerebrovascular accident, terminal creatinine ≥ 132 μmol/L). Only conventional cold storage was used. Our protocol included ATG followed by tacrolimus, mycophenolate mofetil and prednisolone. Outcomes studied were 1-year graft and patient survival, delayed graft function (DGF), biopsy-proven acute rejection (BPAR) and 1-year estimated GFR (MDRD). Results: Between 2004 and 2010, 112 DCD transplants were performed from 78 SCD and 34 ECD kidneys. Median follow-up time was 41 months for SCD and 21 months for ECD transplants. Tables 1 and 2 show the donor and recipient characteristics respectively.Table: [Donor Characteristics]Table: [Recipient Characteristics]Warm and cold ischemia times were significantly shorter for ECD kidneys. Incidence of DGF (68% vs.72%, p=0.7), median duration of DGF (4 vs. 6 days, p=0.5) and incidence of BPAR (5% vs. 12%, p=0.18) were similar in SCD and ECD groups respectively. There was 1 case of primary non-function in the SCD group and 2 of early transplant nephrectomy in the ECD group. One-year graft survival (SCD 95% vs. ECD 94%, p=0.8) and patient survival (SCD 96% vs. ECD 100%, p=0.2) were similar. Median eGFR at 6 months (50 vs. 40 ml/min, p=0.004) and 1 year (53 vs. 41 ml/min, p=0.003) was lower in the ECD group. Conclusion: The proportion of ECD kidneys is increasing within the DCD cohort. One-year graft survival from ECD kidneys is comparable to that obtained from SCD kidneys when cold ischemia time is short, although the one-year allograft function is inferior. These findings warrant further follow-up to determine long-term outcomes from cardiac-death donor ECD kidneys.