POS-800 OUTCOMES OF DECEASED DONOR KIDNEY TRANSPLANTATION AT CHO RAY HOSPITAL, VIETNAM

Abstract

Cho Ray Hospital (CRH) started the kidney transplantation from deceased donor program with donor after brain death (DBD) in 2008, and with donor after circulatory death (DCD) in 2015. The aim of the study was to evaluate the outcomes of the deceased donor program of Cho ray Hospital, Ho Chi Minh City (HCMC), over 12 years. Case series study, both DBD and DCD kidney transplantation at CRH from 2008 to 2020. Of 30 donors, we had 25 DBD, 5 DCD, 24 males. Median age of donors was 39 Yo. 5 donors were extended criteria donor (ECD). 15 donors had Kidney Donor Profile Index < 80%. Causes of donor death included 5 strokes, 25 head traumas. 7 kidneys from 4 DBD were procured outside HCMC, the longest distance was 1712 km. We proceeded 55 kidney transplants (46 pts from DBD and 9 pts from DCD). 4 DBD recipients (DBDR) had second kidney transplant, 1 DCD recipient (DCDR) had dual kidney transplant from an ECD. Median waiting time were 45 months for DCDRs and 39 months for DBDRs (p=0.005). Median HLA mismatches was 4 antigens. Mean cold ischemic time of DCDRs was higher than that of DBDRs (no statistic significant). DCDRs had higher rate of delayed graft function (DGF) than that of DBDRs (77.9% vs 19.5%). Surgical complications were 4 hematomas, 2 ureteral stenosis, 1 symptomatic lymphocele, 1 renal artery thrombosis. Both DCD and DBD recipients had similar graft function at discharge time. Our deceased donor transplant had graft survival of 98.2%, and 84.7% at 1 year, and 5 years and patient survival of 92.7% and 89.5% at 1 year, and 5 years. Acute rejection in the first year and later were 6/55 cases (10.9%) and 5/55 cases (9.1%), respectively. DCDRs had lower graft and patient survival than DBDRs. 5 pts died with graft functioning. The most common infections occurred post-transplant were cytomegalovirus (CMV) infection (19 pts), and polyoma (BK) virus infection (8 pts). Median onset time of CMV and BK infection was 5 months, and 16 months, respectively. Tabled 1AllDCDDBDPNumber of recipients (n)55946Age at kidney Tx (median)3744360.461Male (n)398310.188WIT (min)(median)1213.550.001SWIT (min) (median)3837380.617CIT (h)(median)7.7115.20.065DGF (n)16880.000PNF (n)110Length of stays (days) (median)1227100.095Serum creatinine at discharge (mg%) (median)1.31.71.30.807Induction therapy (n)• Â · IL-2inhibitor397320.836• Â · Leukocyte depletion14212Maintenance immunosuppressive therapy (n)• Â · Tac+MMF/MPA+Pred498410.983• Â · Cyc+MMF/MPA+Pred615Biopsy-proven AR (n)7160.874• Â · ACR5050.300• Â · AMR2110.190Non-biopsy proven AR4130.628Graft survival• Â · At 1-year98.2%88.9%100%0.086• Â · At 5-year84.7%71.1%87.8%Pts survival• Â · At 1-year92.7%66.7%97.8%0.002• Â · At 5-year89.5%66.7%94.2%Death with graft functioning (n)5230.210Death total (n)9360.132Causes of death (n)• Â · Sudden cardiacdeath1010.150• Â · Aortic aneurysmrupture101• Â · Sepsis due tobacteria523• Â · PCP110• Â · SARS-COVI-2101Infection post-transplant (n)• Â · CMV196130.027• Â · BK virus8350.080• Â · PCP6240.234• Â · Pulmonary TB5230.134 Open table in a new tab Deceased donor kidney transplantation at CRH showed feasible outcomes and has increased the chance of kidney transplantation to patients on waiting list.