Login to Access Video or Poster Abstract: MP74-05
Sources of Funding: Schulich Research Opportunities Program, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada

Introduction

In efforts to bridge the gap between the increasing numbers of patients on the waiting list for simultaneous pancreas-kidney (SPK) transplantation, there has been an increase in the use of organs from donors after cardiac death (DCD). DCD allografts represent the fastest growing source of deceased donor organs globally. Although studies have shown that longterm outcomes of DCD-SPK grafts are inferior to those of neurologically deceased SPK grafts, specific information is lacking on which donor factors impact a DCD-SPK organ&[prime]s longterm outcome. The predictive tool PDRI (Pancreas Donor Risk Index) is only proven for short term outcomes and does not heavily weigh factors such as donor age or organ cold ischemic time. Here, we analyzed data from UNOS (United Network for Organ Sharing) to determine the effects of donor age, donor BMI, and cold ischemic time on DCD-SPK graft outcomes.

Methods

We evaluated all DCD-SPK transplants performed in the United States from 1988 to 2013. We excluded transplants with incomplete values required to calculate PDRI and KDRI (Kidney Donor Risk Index). The effects of donor characteristics on graft and recipient survival were evaluated using Cox Regression and the Kaplan-Meier method. Logistic regression was used to evaluate the effects on delayed graft function (DGF).

Results

We analyzed 189 DCD transplants with donors ≤40 years old, and 38 with donors >40. Overall, SPK grafts from donors >40 displayed significantly higher rates of kidney failure (HR 2.10, 95%CI 1.15-3.83, p<0.05) and pancreas failure (HR 2.07, 95%CI 1.16-3.70, p<0.05) compared to grafts from donors ≤40. One year (88.2% ± 2.4% vs 73.4% ± 7.2%) and 10 year (66.3% ± 6.9% vs 50.3% ± 10%) pancreas graft survival were greater in donors ≤40. A similar trend was also observed for both short and longterm kidney graft survival. Importantly, increasing donor age was associated with increased DGF (OR 1.030, 95%CI 1.003-1.057, p<0.05). Increasing donor BMI was also predictive of pancreas failure (HR 1.024, 95% CI 1.007-1.042, p<0.01), recipient mortality (HR 1.022, 95% CI 1.003-1.041, p<0.05), and DGF (OR1.119, 95%CI, 1.035-1.208, p<.005). Donor age was equally as predictive of 1 year graft outcomes as PDRI or KDRI. We did not observe an effect of cold ischemic time on graft or recipient outcomes.

Conclusions

Donor age and donor BMI are significant predictors of DCD-SPK graft failure, DGF, and recipient mortality. Organs from donors >40 are up to twice as likely to result in kidney failure and pancreas failure compared to grafts from donors ≤40.

Funding

Schulich Research Opportunities Program, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada