Clinical Outcome and Cost Analysis of Kidney Transplantation From Extended Criteria Brain Death Donors.

Abstract

B: Because of the scarcity of donor organs other sources of allograft are explored including allografts from extended criteria donors (ECD). M: 620 kidney transplantations from brain death donors were classified into ECD or standard criteria donation (SCD). The occurrence of delayed graft function (DGF) and acute rejection, the length of hospital stay and total medical costs during the first 3 months and renal function at 3 months and 1 year after transplantation were analyzed. For survival analysis, follow-up extended to 9 years. R: 435 patients received SCD allografts, and 185 patients received ECD allografts. ECD allografts had an increased incidence of DGF (23% vs. 14%, p = 0.006), but not when adjusted for other risk factors. Graft function at 3 and 12 months was worse in ECD allografts, independently from donor age (eGFR 38 ± 13 ml/min/1.73m2 vs. 51 ± 17 ml/min/1.73m2, p = 0.010 and eGFR 43 ± 13 ml/min/1.73m2 vs. 57 ± 18 ml/min/1.73m2, p = 0.003, respectively). There was no difference in the incidence of acute rejection between SCD and ECD allografts (16% vs. 15%). Patient and allograft survival were worse in ECD recipients, with a trend towards worse death-censored allograft survival. In a multivariate Cox proportional hazards analysis including donor age, ECD-status remained an independent predictor for allograft survival (HR 1.672, 95% CI 1.089 - 2.565). ECD-status was associated with longer duration of hospital stay (30 ± 25 days vs. 24 ± 19 days, p < 0.001) and higher medical costs (€ 40,156 ± 26,770 vs. € 34,309 ± 18,775, p < 0.001), but not independently from donor age. The main determinants of length of hospital stay and medical costs were donor and recipient age, DGF and acute rejection. C: The use of ECD allografts posed a risk for worse renal allograft function and allograft survival, on top of older donor age inherently part of ECD allografts. ECD-status was not an independent risk factor for DGF and death-censored graft survival. The costs associated with ECD allograft transplantation are considerable higher compared to SCD allograft transplantation. Importantly, ECD status was not independently associated with longer duration of hospital stay and higher medical costs.