NIV Congres

Background As the need for transplantable organs is high, acceptance criteria for presumed deceased donor quality have been relaxed through the years. However, we are confronted with non viable kidneys (NVKs). Is it possible to identify factors that predict NVK?

Methods Recipients included received a deceased donor kidney transplant between January 2000 and April 2012. Deceased donor information was extracted from ET database using donor ET number. Missing values were requested from local Donor centres. Cox was performed with event NVKs. Donor variables included are: ischemia times, age, gender, BMI, type, cause of death, atherosclerosis, hypertension, diabetes, cardiovascular disease, cardiac arrest, hypotension, proteinuria and first serum creatinin. Recipient factors studied were: age, gender, waiting time, PRA, HLA-mismatches,

Results 582 patients were transplanted in the period studied: 366 heart-beating (HB, 63%) and 216 non-heart-beating (NHB) donations. 13 of the latter were NHB-II. 78.4% of donor procedures were done in the Netherlands. Amongst 38 NVKs the prevalence of NHB and HB donor kidneys was not significantly different. Donor age was above 45 years in all cases. NVKs were significantly more often from males, with more atherosclerosis, more hypertension, longer cold ischemia time (CIT), first warm ischemia time (WIT1), second warm ischemia time (WIT2), higher donor and recipient age and there were more HLA mismatches. In multivariate Cox analysis only donor age, CIT and hypertension had a significant influence on the prevalence of NVKs (p<0.001, <0.001 respectively 0.001). There was no interaction between these variables. The NVK risk of a 50 year old donor kidney after 24 hours CIT is equivalent to that of 16 hours for a 60 year old and 8 hours for a 70 year old donor kidney. Donor hypertension has a RR for NVK of 3.3 on top of that. However, in our population donor age>65 years ánd CIT>1300 minutes prevailed in only 18% of recipients of NVKs.

Conclusion No single set of factors can predict NVKs. Donor type did not influence the prevalence of NVKs. As CIT is the only adjustable factor: ultra-short CIT should be aimed at in elderly donors, especially in the presence of donor hypertension.