Shipped Versus Locally Transplanted Kidneys

Abstract

Background Shipping of well-matched renal allografts is still an important part of the organ allocations programs in most countries, based on demonstrated survival advantage. The aim of this study was to assess whether the shipment of deceased kidneys negatively influences early graft function. Methods Between January 1, 2007 and December 31, 2015, 555 deceased donor kidney alone transplantations were performed our center. Among them, 268 (48%) were procured and transplanted by the local transplant team (=Locally transplanted kidneys, LTK group) and 287 (52%) were procured by another national or international center, shipped and transplanted (=Shipped transplanted kidneys, STK group). Donor and recipient characteristics were compared. Primary endpoints were 1) incidence of delayed graft function and time to reach an estimated glomerular filtration rate (eGFR) >40 ml/min/1.73m2. Secondary endpoints were 1) clinical biopsy proven acute rejection (BPAR) incidence and 2) 1, 3 and 5 years graft- and patient survivals. Results The mean (±SD) cold ischemia time was 15h28±5h13 and 14h05±4h47 in the LTK and STK group (p=0.040), respectively. The incidence of primary non-function (1.5% LTK versus 1.7% STK, p=0.88), delayed graft function (11% LTK versus 13% STK, p=0.55) and time to reach an eGFR>40 ml/min/1.73m2 (p=0.126) was comparable between both study groups. Twenty-four (9%) and 33 (12%) patients never reached an eGFR>40 ml/min/1.73m2 after transplantation in the LTK and STK group, respectively (p=0.332). The incidence of BPAR during the first year posttransplant was 26 (10%) and 23 (8%) in the LTK and STK group (p=0.55), respectively. The 1, 3 and 5 years patient- and death-censored graft survivals were 98%, 96%, 92% versus 98%, 94%, 91% (p=0.935) and 96%, 89%, 82% versus 92%, 88%, 83% (p=0.373) in the LTK and STK group, respectively. Discussion Most studies in literature about shipping of renal allografts focus on the importance of HLA matching. This study clearly demonstrates no negative impact of shipping on early graft function focusing on primary non-function, delayed graft function, time to reach GFR>40ml/min/1.73m2 and incidence of acute rejections episodes and also demonstrates comparable long term outcome. Conclusion Shipped deceased kidneys did not have a negative influence on early graft function compared to locally transplanted kidneys and demonstrated comparable patient- and graft outcomes.