MP59-06 KIDNEY TRANSPLANTATION FROM EXTENDED-CRITERIA DONORS

Abstract

INTRODUCTION AND OBJECTIVE: Due to the increasing need for kidneys suitable to transplantation, the scientific comunity has expanded the donor population to include extended criteria donors (ECD). Although the use of ECD organs has increased, the implication of such a strategy in terms of urological and ureteral complications has been only marginally analysed. The objective of this work is to evaluate the impact of EDCs on urologic complications. METHODS: Between January 1, 2002 and December 31, 2017, 10279 kidney transplants on adult recipients were recorded within the DIVAT network (Données Informatisées et VAlidées en Transplantation /Computerized and VAlidated Data in Transplantation). Data were extracted from the entire network in relation to 137 pre- and post-operative variables regarded as relevant to the development of urological complications. ECD status was included, according to UNOS (United Network for Organizational Sharing) definition. (Extended criteria Donor). Univariate and multivariate analysis were performed to detect any correlation between the variables and urological complications at 1 year. The main analysis focused on the association between the donor's ECD status and all urological complications at 1 year and then among the stenosis, fistula and reflux subgroups. RESULTS: The donor's ECD status was significantly associated with an increased risk of urologic complications at 1 year in univariate analysis (OR: 1.66 (1.47-1.88), p <0.001, RR: 1.374). Multivariate analysis confirmed this association (OR: 1.50 (1.31-1.71), p <0.001). Additional analysis showed that ECD status was significantly associated with ureteral stenosis at 1 year (OR: 1.70 (1.40-2.05), p <0.001, RR: 1.498), ureteral fistulas at 1 year (OR: 1, 62 (1.30-2.03), p <0.001, RR: 1.504) but not ureteral reflux at 1 year (OR 0.89 (0.62-1.27), p <0.532). The perfusion with ypothermic pulsatile machine did not reduce the risk of urological complications at 1 year. The placement of a JJ stent confirmed beneficial in preventing urological complications in all donors (ECD and not). CONCLUSIONS: The donor's ECD status is associated to higher likelihood of stenoses and ureteric fistulas at 1 year. Recipients of grafts from an ECD donors should probably be considered for closer urological monitoring and systematic preventive measures to reduce the associated risk of these complications. Source of Funding: 0