Current Profiles of Kidney Transplant Recipients and their Donors in Spain

Abstract

Objective: To define the anthropometric, demographic and clinical characteristics and specific profiles of kidney transplant (KT) recipients in Spain, as well as their donor characteristics. Methods: Observational, cross-sectional, multicenter study conducted as retrospective clinical records review in KT units nationwide. The last 23 adult KT recipients of 2010 were consecutively reviewed in each center. Multiorgan transplants were excluded. Results: 11 hospitals included 253 KT recipients (mean age 53.9±14.5 y, 68.0% men) and their donors (mean age 54.7±14.8 y, 55.3% men). Mean cold ischemia time was 17.4±5.9 h in cadaveric donors (84.8%) and 1.5±1.1 h in living donors (15%). Donor mean serum creatinine level was 1.2 mg/dl (CI95%: 0.7-1.7), being >1.5 in 5.9%. Main causes of donor death were cerebrovascular accident (60%) and cranioencephalic trauma (14.1%). Most common causes for transplant were: glomerulonephritis (26.1%), polycystic disease (18.2%) and DM (16%). 95.3% were simple KT (first transplant in 84.2% of cases). 14.6% of recipients received a pre-emptive KT. Recipients mean BMI was 25.6±3.8 Kg/m2 (41.5% normal BMI, 39.9% overweighed, 13.4% obese). 22.5% of recipients had pre-transplant DM and the investigators considered that 30% of the non-diabetic at transplant were at risk of NODM. 11.1% had ischemic heart disease history, 8.7% peripheral vascular disease, and 42.3% moderate/ severe atheromatosis. Regarding the specific patient profiles: 5.5% were high immunological risk recipients, 15% were living donor recipients (13.2%of donors were >60y), 36.8% were recipients with cardiovascualr risk and/or DM, 45.5% were expanded criteria donor recipients (>60 y, or >55 y with at least one of the following: hypertension, SCr>1.5 mg/dl or death from cerebrovascular accident) and 54.5% were at risk of delayed graft function. Conclusions: The Spanish KT recipients are a middle-aged and overweighed population with a considerable rate of cardiovascular disease history and posttransplant NODM risk, that receive in almost 50% an extended criteria donor kidney. This population is far from the one included in clinical trials, and will require a specific tailored immunosuppression to try to avoid DGF, preserve renal function on the long term, and minimize posttransplant cardiovascular events.