Increased risk for transplant failure after transplantation with kidneys donated after cardiac death in the Netherlands
F. van Ittersum, M. van Diepen, A. Hemke, F.W. Dekker, A.J. Hoitsma
Location(s): Rondgang 1e verdieping
Category:
Introduction. Since the number of patients on the kidney waiting list started to increase from about 1980, new categories of organ donor organs have been added. An important contribution to the number of donor kidneys is donation after cardiac death (DCD, “non-heart beating”). Unfortunately, these kidneys may have experienced a longer period of ischaemia and, may have, as a consequence, more irreversible damage. Therefore, we evaluated patient and graft outcomes after DCD kidney transplantation in comparison with DBD (donation after brain death) transplantations in a Dutch transplant cohort, stratifying by age and diabetes. Methods. All baseline and follow-up data of postmortal kidney transplantations between 1995 and 2005 in the Netherlands were derived from the Nederlandse Orgaan Transplantatie Registratie (NOTR). We included all first kidney transplants in recipients ≥ 18 years. Relative risks were analyzed by calculating hazard ratios (HR [95% CI]) with Cox proportional hazard models with DCD as determinant. We adjusted for confounding factors in three steps: 1) for donor characteristics such as gender, creatinine, death cause and history of hypertension; 2) for the confounders of step 1) and HLA sharing, cold ischaemia time, and year of transplant; 3) for the confounders of step 2) and recipient characteristics such as age, gender, previous dialysis duration and PRA. Absolute risk differences for graft failure and death were analyzed by calculating incidence density differences (IDD). Results. We identified 3062 kidney transplantations (mean recipient age 49.0 (SD 12.8) years; 59% male; 702 DCD). In general, after adjusting for confounders, DCD kidneys had a higher risk for graft failure, but not for death. Death censored graft failure: HR (step 3) 1.67 [1.40 – 1.99]; unadjusted IDD 16.4 [9.4 to 23.4] / 1000 person years. Death with functioning graft: HR 0.85 [0.69 – 1.05], IDD death with functioning graft -7.3 [-13.1 to -1.5] /1000 person years. Long-term death: HR 1.09 [0.93 to 1.28]; unadjusted IDD -1.1 [-8.1 to 5.8] / 1000 person years;). In the age and diabetic subgroups, these results were similar.
Conclusion. DCD kidney grafts have a higher risk for transplant failure than DBD grafts. Based on these results, subgroups that have less harm of this disadvantage cannot be identified.