Login to Access Video or Poster Abstract: MP74-01
Sources of Funding: none

Introduction

The shortage of organ donation has led to increasing use of kidneys from marginal deceased donors. The number of kidney transplantation from donors after cardiac death (DCD) has increased even in the United State. More than 90% of all deceased kidney transplantation (DKT) in Japan had been obtained from DCD before 2009. The objectives of this study are to elucidate the clinic-pathological factors that predict outcomes after DKT from DCD.

Methods

We retrospectively analyzed 59 recipients who received DKT from DCD between 1995 and 2013 in Niigata University Hospital. Graft function was assessed using estimated glomerular filtration rate (eGFR). The recipients were divided into two groups, stable graft function (Group 1. N=44) and poor graft function that eGFR decreased ≥ 25% after transplantation (Group 2. N=15). We performed histologic analysis of preimplantation biopsies. Expanded criteria donor (ECD) is defined as all deceased donors older than 60 years and donors older than 50 years with 2 of the following: hypertension, stroke as the cause of death, or preretrieval serum creatinine greater than 1.5 mg/dl.

Results

5, and 10 years graft survival before 2001 were 61.9%, and 54.2%, respectively. In contrast, graft survivals were dramatically improved since 2002, such as 5, and 10 years graft survival were 87.4%, and 83.0%, respectively. Multivariate analysis revealed that arteriolar hyalinization (P=0.046) and ECD (P=0.046) were significantly associated with poor graft function and graft survival (Figure 1). When the recipients were divided into 4 groups according to graft function after transplantation (Improved: eGFR increased ≥ 25% after transplantation / Stable / Decreased: eGFR decreased ≥ 25% after transplantation / Primary non-function), degree of severity of arteriolar hyalinization was associated with renal function (Figure 2).

Conclusions

Arteriolar hyalinization predicts clinical outcome after DKT from DCD. This histologic factor may guide clinical decisions regarding use, allocation, or minimization of immunosuppression.

Funding

none