Deciphering transplant outcomes of expanded kidney allografts donated after controlled circulatory death in the current transplant era. A call for caution
Por:
Montero, N, Toapanta, N, Pallares, N, Crespo, M, Diekmann, F, Guirado, L, Esteban, R, Codina, S, Melilli, E, Buxeda, A, Velis, G, Torres, IB, Revuelta, I, Andujar, AM, Facundo, C, Bardaji, B, Riera, L, Fiol, M, Cruzado, JM, Comas, J, Giral, M, Naesens, M, Asberg, A, Moreso, F, Bestard, O
Publicada:
1 dic 2021
Ahead of Print:
1 oct 2021
Resumen:
Outcomes of kidney transplantation (KT) after controlled circulatory death (cDCD) with highly expanded criteria donors (ECD) and recipients have not been thoroughly evaluated. We analyzed in a multicenter cohort of 1161 consecutive KT, granular baseline donor and recipient factors predicting transplant outcomes, selected by bootstrapping and Cox proportional hazards, and were validated in a contemporaneous European KT cohort (n = 1585). 74.3% were DBD and 25.7% cDCD-KT. ECD-KT showed the poorest graft survival rates, irrespective of cDCD or DBD (log-rank < 0.001). Besides standard ECD classification, dialysis vintage, older age, and previous cardiovascular recipient events together with low class-II-HLA match, long cold ischemia time and combining a diabetic donor with a cDCD predicted graft loss (C-Index 0.715, 95% CI 0.675-0.755). External validation showed good prediction accuracy (C-Index 0.697, 95%CI 0.643-0.741). Recipient older age, male gender, dialysis vintage, previous cardiovascular events, and receiving a cDCD independently predicted patient death. Benefit/risk assessment of undergoing KT was compared with concurrent waitlisted candidates, and despite the fact that undergoing KT outperformed remaining waitlisted, remarkably high mortality rates were predicted if KT was undertaken under the worst risk-prediction model. Strategies to increase the donor pool, including cDCD transplants with highly expanded donor and recipient candidates, should be performed with caution.
Filiaciones:
Montero, N:
Hosp Univ Bellvitge, Nephrol Dept, Kidney Transplant Unit, Feixa Llarga S-N, Barcelona 08907, Spain
Toapanta, N:
Hosp Univ Vall Hebron, Nephrol Dept, Kidney Transplant Unit, Barcelona, Spain
Pallares, N:
Bellvitge Biomed Res Inst IDIBELL, Biostat Unit, Lhospitalet De Llobregat, Spain
Crespo, M:
Hosp Mar, Nephrol Dept, Kidney Transplant Unit, Barcelona, Spain
Diekmann, F:
Hosp Clin Barcelona, Inst Invest Biomed August Pi i Sunyer, Nephrol Dept, RedlnRen,Kidney Transplant Unit, Barcelona, Spain
Guirado, L:
Fundacio PuigVert, Kidney Transplant Unit, Nephrol Dept, Barcelona, Spain
Esteban, R:
Hosp Univ Bellvitge, Nephrol Dept, Kidney Transplant Unit, Feixa Llarga S-N, Barcelona 08907, Spain
Codina, S:
Hosp Univ Bellvitge, Nephrol Dept, Kidney Transplant Unit, Feixa Llarga S-N, Barcelona 08907, Spain
Melilli, E:
Hosp Univ Bellvitge, Nephrol Dept, Kidney Transplant Unit, Feixa Llarga S-N, Barcelona 08907, Spain
Buxeda, A:
Hosp Mar, Nephrol Dept, Kidney Transplant Unit, Barcelona, Spain
Velis, G:
Hosp Mar, Nephrol Dept, Kidney Transplant Unit, Barcelona, Spain
Torres, IB:
Hosp Univ Vall Hebron, Nephrol Dept, Kidney Transplant Unit, Barcelona, Spain
Revuelta, I:
Hosp Clin Barcelona, Inst Invest Biomed August Pi i Sunyer, Nephrol Dept, RedlnRen,Kidney Transplant Unit, Barcelona, Spain
Andujar, AM:
Hosp Clin Barcelona, Inst Invest Biomed August Pi i Sunyer, Nephrol Dept, RedlnRen,Kidney Transplant Unit, Barcelona, Spain
Facundo, C:
Fundacio PuigVert, Kidney Transplant Unit, Nephrol Dept, Barcelona, Spain
Bardaji, B:
Fundacio PuigVert, Kidney Transplant Unit, Nephrol Dept, Barcelona, Spain
Riera, L:
Hosp Univ Bellvitge, Urol Dept, Barcelona, Spain
Fiol, M:
Hosp Univ Bellvitge, Urol Dept, Barcelona, Spain
Cruzado, JM:
Hosp Univ Bellvitge, Nephrol Dept, Kidney Transplant Unit, Feixa Llarga S-N, Barcelona 08907, Spain
Comas, J:
Catalan Organ Transplant Org, Barcelona, Spain
Giral, M:
Univ Nantes, RTRS Centaure, CHU Nantes, ITUN,CRTI UMR 1064,Inserm, Nantes, France
Naesens, M:
Katholieke Univ Leuven, Dept Microbiol Immunol & Transplantat, Leuven, Belgium
Asberg, A:
Oslo Univ Hosp, Dept Transplantat Med, Oslo, Norway
Univ Oslo, Dept Pharm, Oslo, Norway
Moreso, F:
Hosp Univ Vall Hebron, Nephrol Dept, Kidney Transplant Unit, Barcelona, Spain
Bestard, O:
Hosp Univ Bellvitge, Nephrol Dept, Kidney Transplant Unit, Feixa Llarga S-N, Barcelona 08907, Spain
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