MO964: High Urgency Renal Transplantation for Patients With Exhaustion Of Vascular Access for Haemodialysis: Experience from A Tertiary Center

Abstract

Abstract BACKGROUND AND AIMS When faced with exhaustion of vascular access for haemodialysis (EVAH), allocation for High Urgency Renal Transplantation (HURT) is the appropriate solution. Patients with EVAH usually have multiple comorbidities and an increased risk of cardiovascular and thrombotic events. The aim of this study is to analyze the characteristics and outcomes of patients undergoing HURT due to EVAH. METHOD Data from the Renal Transplant Unit since January 2006 were retrospectively analyzed. Eleven patients undergoing HURT were identified. RESULTS In the population studied, 45.5% (n = 5) were male, 63.6% (n = 7) were Caucasian and the mean age at the time of transplantation was 41.6 ± 7.8 years. Ninety % (n = 10) were hypertensive, 27.3% (n = 3) were diabetic and 27.3% (n = 3) had previous cardiovascular disease. Patients were on renal replacement therapy for 5.8 ± 2.7 years prior to transplantation. The mean transplant time was 75.5 ± 53.7 months. The mean follow-up period was 90.6 ± 51.9 months. During this period, 63.6% (n = 7) of patients lost their renal graft and mortality was 63.6% (n = 7). Renal graft survival was 81.8% (n = 9) at the first year, 72.7% (n = 8) at the third year and 63.6% (n = 7) at the fifth year of follow-up. At discharge, mean creatinine was 1.8 ± 1.1 mg/dL. At the first year, mean creatinine was 1.9 ± 0.8 mg/dL, at the third year was 2.3 ± 1.9 mg/dL and was 1.6 ± 0.4 mg/dL at the fifth-year post-transplant. The mean time to graft loss was 54.1 ± 49.3 months. Overall survival was 90.9% (n = 10) at the first year, 90.9% (n = 10) at the third year and 81.5% (n = 9) at the fifth-year post-transplantation. Two patients died from a cardiovascular event, one from neoplasia and other from an infectious cause. Two patients died with a functioning kidney allograft. CONCLUSION Kidney graft survival in patients undergoing HURT was significantly lower. Portuguese Transplantation Society reporting an overall graft survival of 92.9% at the first year and 85.0% at the fifth year. The mortality of these patients is quite high; however, the fact that they are patients with EVAH, whose life expectancy would be greatly reduced if they were not transplanted, makes HURT continue to be an indicated option in this population of more vulnerable patients.