NIV Congres

In the Netherlands organ donation after cardiac death type 3 (DCD3) is common practice. Recently, we observe an increase in the percentage of DCD3 donors older than 60 years of age (60+DCD3). In 2007 there were only 23 (26%) 60+DCD3 donors, while in 2012 (cut-off date 21-11-2012) this number is already 42 (40%). We question whether the use of 60+DCD3 kidneys  has an impact on short term graft function and survival.

We analyzed short-term graft function and survival in first kidney transplantations performed in the Netherlands between 1-1-2007 and 1-1-2012 with kidneys from donors after brain death over 60 years of age (60+DBD), 60+DCD3 donors and DCD3 donors of 60 years of age or younger (60-DCD3). Data was obtained from the Dutch Transplant Follow up Registry (NOTR). The results are based on 157 transplanted  60+DCD kidneys, 446 60-DCD3 kidneys and 258 60+DBD kidneys. For statistical analysis the Chi-Square, Kaplan Meier, Log Rank and Cox regression analysis were used.

The 60+DCD3 kidneys have 62% delayed graft function (DGF) and 13% never function, 60-DCD3 kidneys have 56% DGF, 7% never function, and 60+DBD kidneys 24% DGF, 5% never function; p<0.001. Death censored half year graft survival was 85% for 60+DCD3 kidneys, 92% for 60-DCD3 kidneys and 93% for 60+DBD donors (p=0.02). To include warm ischemia time, the multivariate Cox regression was performed on only the DCD3 kidneys. 60+DCD3 kidney had a Hazard ratio of 2.4 (95%CI: 1.2 – 4.5, p=0.01), warm ischemia time above 20 minutes had a HR of 2.2 (95%CI: 1.2 – 3.9, p=0.01), cold ischemia time above 20 hours a HR of 1.7 (95%CI: 0.9.2 – 3.2, p=0.09), donor hypertension a HR of 1.8 (95%CI: 0.99 – 3.2, p=0.055), donor serum creatinine a HR of 0.99 (95%CI: 0.98 - 1.01, p=0.3) and recipient age a HR of 0.99 (95%CI: 0.99 – 1.02, p=0.49).

In conclusion, 60+DCD3 kidneys perform less than younger DCD3 kidneys after transplantation. Limiting warm ischemia time and choosing donors without hypertension can reduce poor outcome.