Login to Access Video or Poster Abstract: MP30-16
Sources of Funding: None

Introduction

Donation after circulatory death (DCD) renal transplants are associated with long-term outcomes comparable to that of donation after neurological donor death (NDD) transplants, but the effect of longer functional warm ischemia time during withdrawal is unknown. Nevertheless, a hard cutoff of 2 hours warm ischemic time has been used to exclude the use of DCD donors.

Methods

We retrospectively analyzed the impact of mean arterial pressure (mAp) <55 during donation for different time points (30, 45, 60, and 90mins) on delayed graft function time (DGF), creatinine clearance (CrCl) at 1 year and overall graft survival. A total of 190 single donations after DCD renal transplants were performed at our institution between July 2006 and June 2016. Outcome variables such as CrCl, hospital stay, readmission rate, DGF and overall graft loss and rejection were compared between groups using the Student t-test and the Pearson chi-square test. A linear regression model was also used for independent prognostication.

Results

Mean age of recipients and donors were 54.7 and 44 years old respectively and 13% of the population were expanded criteria donors. Patients were followed for a median of 39 months (range 1 - 122 months). The mAp<55 was not associated with DGF (X2=0.06, p=0.81), patient death (X2=0.81, p=0.34), graft failure (X2=0.40, p=0.53), cell mediated (X2=0.84, p=0.36) or antibody-mediated rejection (X2=1.25, p=0.26) of the graft. Independent multivariate regression model looking at mAp<55 as an independent predictor of Cr Cl at 7 days (p=0.10), 1 month (p=0.20), 3 month (p=0.09) or 1 year (p=0.63) and patient survival (p=0.82), graft survival (p=0.17), length of stay (p=0.35), length of readmission (p=0.24) did not show any significance. However higher CrCl at 7 days (R2=0.16, F(3, 105)=6.99, p <0.05) was an independent predictor of total warm ischemia time.

Conclusions

The duration of actual and functional warm ischemic time was not associated with DGF, patient death, graft failure or rejection nor for patient or graft survival. The CrCl at 1 week was an independent prognosticator of actual warm ischemic time but not for functional warm ischemic time. Utilization of selected DCD donors with warm ischemic times > 2 hr should be considered.

Funding

None