Kidney Transplant Outcomes Research Articles

P8.118: Effect of Donor vs Recipient Delta of Age and BMI on Kidney Transplantation Outcome

Introduction: An ongoing challenge is the significant gap between organ supply and demand, which requires increased awareness for organ donation and for the decision-making process in accepting a graft. A donor offer requires careful consideration of various features, both donor and recipient, and despite the acute shortage of graft for kidney transplantation, each year more cadaveric kidneys are discarded because of unsuitability. The purpose of the study is to evaluate the effect of the difference of age and BMI between donor and recipient on single kidney transplantation (SKTx) outcome. Method: We considered all patients underwent deceased SKTx from 2005 to 2021 at a single Center. The Δ-age was calculated as the difference between donor’s and recipient’s age. The Δ-BMI was calculated as the difference between donor’s and the recipient’s BMI. The effect of Δ-age and &DeDelta;-BMI was calculated, as odd ratio (OR), with respect to PNF, DGF, acute rejection, 3-month and 1-year eGFR. The ROC curve analysis was used to determine the cut-off value of significance of the Δ-age and Δ-BMI on the outcome. Results: 354 SKTx were included in the analysis. The median Δ-age was 5 (range 0/11) years. The Δ-age was statistically associated to PNF (p=0.01), with an OR 1.11 (1.02-1.21), to DGF (p=0.03), with an OR 1.03 (1.00-1.05), and to acute rejection (p=0.0049), with an OR 1.05 (1.01-1.09). The Δ-age was also statistically associated to 3-month and 1-year e-GFR (p<0.001, est=-0.37 ±0.09 and p=0.004, est =-0.31 ±0.11). The cut-off value of Δ-age significatively associated to PNF was 19 years (AUC 0.74). Similar value related to DGF was 8 years (AUC 0.58) and that related to acute rejection was 5 years (AUC 0.65). The median Δ-BMI was 1.3 (range -1.2/4.5). The Δ-BMI was not statistically associated to any studied variables: PNF (p=0.25), DGF (p=0.55) acute rejection (p=0.37), 3-month e-GFR (p=0.35) and 1-year e-GFR (p=0.34). Conclusions: In this study Δ-age >19 years is associated to a higher PNF rate and lower e-GFR so could be a useful parameter to evaluate in case of fragile recipient. Δ-age can be an easy parameter for immediate help in deciding if accepting or declining a donor according to the selected recipient.

P8.059: Kidney Transplant Outcome According to Pre-transplant Dialysis Modality

P8.059: Kidney Transplant Outcome According to Pre-transplant Dialysis Modality

P8.079: Systematic Review and Meta-Analysis on the Effect of Blood Transfusions on Kidney Transplant Outcomes: Shining New Light on an Age-Old Debate

Introduction: Since the 1970’s, the use of transfusions in kidney transplant medicine has been a point of contention. While they are a solution to the anaemia plaguing this patient population and in 1978 were shown to lead to a dose-dependent improvement in graft survival, they also have the ability to induce a sensitized state, increasing the risk for poorer graft outcomes. Influenced by the inherent risk, clinicians have begun to administer transfusions based on clinical need as opposed to deliberately. Furthermore, the popularity and efficacy of tacrolimus as an immunosuppressant over the past two decades, has allowed for a degree of standardization across different kidney transplant centres. The majority of the studies in the past two decades have focused on previously understudied postoperative blood transfusions, occurring in 40-60% of cases. No systematic reviews or meta-analyses have been published including these newer studies. With these details in mind we believed it prudent to undertake a systematic review and meta-analysis exploring the effect transfusions have on transplant outcomes. Methods: A systematic search was conducted using MEDLINE, Embase, Cochrane library and Clinicaltrals.gov. Including only English articles published between 1/1/2000 and 01/03/2022, we found 9 studies that met our inclusion criteria. A meta-analysis was thereby carried out for three outcomes, delayed graft function (DGF), the development of de novo donor specific antibodies, and antibody mediated rejection (AMR). Results: Low-level evidence exists for no difference or an increase in DGF and AMR for participants who received at least one blood transfusion. Low-level evidence exists for an increase in AMR for participants who received at least one blood transfusion. For the outcomes not included in the meta-analysis (graft loss/failure, graft survival, acute rejection, development of HLA-Abs, sepsis), each of the included studies reported either no difference or a detrimental effect on the outcomes. No study reported any improvement with blood transfusion usage. Conclusion: The transfusion effect appears not to exist in the 21st century even in patients receiving postoperative blood transfusions. However, while transfusions are avoided wherever possible and despite a myriad of replacements becoming available, transfusions in kidney transplant recipients do not appear to be associated with any worse outcomes compared to their non transfused counterparts. While more research is required, clinicians may be able to administer blood transfusions to kidney transplant patients with a clear conscience.

417.9: A Pre-transplant Risk Assessment Tool for Outcome in Pediatric Kidney Transplantation Based on a Dutch Cohort of 1415 Patients

417.9: A Pre-transplant Risk Assessment Tool for Outcome in Pediatric Kidney Transplantation Based on a Dutch Cohort of 1415 Patients

316.7: ABO – Incompatible Kidney Transplantation in COVID 19 Era: A Single Centre Experience

Introduction: Though there are multiple studies on outcome of ABO incompatible kidney transplants, we herein present the short term outcome of ABO-incompatible kidney transplantations done in the Covid-19 era. Methods: We analysed 40 consecutive ABO incompatible kidney transplant recipients undergone transplant from October 2020 till February 2022, followed up till March 2022.Included patients received rituximab 100 mg/200 mg depending on baseline anti ABO titre, plasma exchange and IVIG for desensitization. Target pre transplant anti ABO titre was ≤ 1:64.Patients received induction therapy with anti thymocyte globulin and IV methylprednisolone. Results: The median duration of follow up was 294 days. The highest baseline and pre transplant titre were 2048 and 64 respectively. The mean serum creatinine at discharge was 1.35±0.39 mg/dl and at follow up was 1.48 ± 0.59 mg/dl.The patient and death censored graft survival were 97.5% each. The single graft and patient loss was due to fungal pyelonephritis. 5 patients (12.5%) experienced episodes of biopsy proven rejection.3 patients (7.5%) had acute antibody mediated rejection and 2 patients (5%) suffered T Cell Mediated rejection. The post-transplant hospital stay was 12.79 ± 4.61 days. 5 patients needed hospitalisation for infection in the post transplant follow up period. 10 covid-19 recovered patients were transplanted after a mean duration of 88.4 days with mild to moderate severity. 3 patients (7.5%) acquired covid-19 post-transplantation, 2 in early post transplant (<3 months) and 1 patient at 5 months post-transplant period. Conclusion: There were no significant differences in the patient and graft survival in covid-19 era as compared to our pre covid studies. Rather, they had lower infection rates due to covid-19 related precautions. There was no increase in mortality or infection in a shorter term of follow up of our study period. Keywords: Short term outcome, ABO incompatible kidney transplantation, Covid19 Era.

316.6: Comparative Study of Medium Term Outcomes of ABO Incompatible Kidney Transplantation With ABO Compatible Kidney Transplantations

316.6: Comparative Study of Medium Term Outcomes of ABO Incompatible Kidney Transplantation With ABO Compatible Kidney Transplantations

417.4: Outcomes of Single Kidney Transplantation From Pediatric Donors With Acute Kidney Injury Into Pediatric Recipients

417.4: Outcomes of Single Kidney Transplantation From Pediatric Donors With Acute Kidney Injury Into Pediatric Recipients

P16.22: Graft and Patients’ Outcome in Kidney and Simultaneous Liver-Kidney Transplantation With Infection Control Measures And Immune Suppression Adjustment During COVID-19 Era

P16.22: Graft and Patients’ Outcome in Kidney and Simultaneous Liver-Kidney Transplantation With Infection Control Measures And Immune Suppression Adjustment During COVID-19 Era

P8.103: Main Clinical Outcomes in Living-Donor Kidney Transplantation: A Latin-American Cohort

P8.103: Main Clinical Outcomes in Living-Donor Kidney Transplantation: A Latin-American Cohort

311.7: Outcomes of Preemptive Second Kidney Transplant by Induction Type in the United States

Background: The role of induction in preemptive second kidney recipients is unclear. We examined the association between induction therapy and the long-term graft and recipient survival in the settings of tacrolimus and mycophenolate maintenance. Methods: We identified all preemptive second kidney transplant recipients between 2000 and 2020 in the Scientific Registry of Transplant Recipients. We excluded those with missing or mixed induction regimens and positive crossmatch. We grouped recipients by induction type into three groups: Anti-thymocyte globulin (n=1442), Alemtuzumab (n=362), IL-2 Receptor Antagonist (n=481). We generated Kaplan-Meier curves of the recipient and death-censored graft survival (DCGS) with follow-up censored at ten years. We used multivariable Cox Proportional Hazards models to examine the association between induction and the above outcomes. We adjusted the models for recipient and donor variables. Results: Rates of delayed graft function (DGF), rejection, hospitalization, and post-transplant lymphoproliferative disorder (PTLD) at one year were not statistically different. Recipient survival did not vary by induction type in the Kaplan-Meier analysis (log-rank P=0.189) or in the multivariable model.However, DCGS was the lowest in the Alemtuzumab group (log-rank P=0.01).In the multivariable models, alemtuzumab was associated with a 57% increased risk of graft loss [1.57, 95% C.I. (1.08, 2.30), P=0.019] compared to anti-thymocyte. Live-donor kidneys were associated with significantly better recipient survival [aHR 0.67, 95% C.I. (0.51, 0.89), P = 0.005] and DCGS [aHR 0.55, 95% C.I. (0.40, 0.76), P < 0.001]. Conclusion: Compared to anti-thymocyte induction, alemtuzumab, but not IL-2RA, was associated with inferior graft survival in preemptive second transplant recipients discharged on tacrolimus and mycophenolate.

P8.031: Outcome of Simultaneous Pancreas Kidney Transplantation A Single Center Experience

Introduction: Simultaneous simultaneous pancreas-kidney (SPK) transplantation is one of the treatment options for type 1 diabetes mellitus (T1DM) patients with chronic kidney disease stage 5. The SPKT outcomes are reported to be excellent with a 5 year patient, kidney and pancreas graft survival of 88%, 77% and 69% respectively. Here, we present data regarding outcome of the SPKT done at our institution. Method: We studied patients who underwent SPKT in our institution. 11 T1DM patients who were CKD-5 underwent SPKT from 2014 to 2022. Their graft function and complications were analysed. Results: A total of 12 patients were studied. 50 % were males and 50% were females. Mean age at diagnosis was 14 ± 4 years. Mean age at transplantation was 32 ± 6 years. Mean hemodialysis (HD) vintage was 22 ± 14 months. Mean age of donor was 31 ± 10 years. Induction was with Basiliximab in 1 patient, Alemtuzumab in 5 patients and ATG in 6 patients. Maintenance immunosuppression was tacrolimus and mycophenolate in 8 patients; and, tacrolimus, mycophenolate and everolimus in 2 patients Mean duration of hospital stay was 30 ± 18 days. Mean graft kidney function at 1 month was 1.38 ± 0.48 mg/dl. Mean graft kidney function at 6 months was 1.30 ± 0.47 mg/dl. At 1 year, one patient had severe renal graft dysfunction requiring HD. Among the other 10 patients who completed one year, mean kidney graft function at 1 year was 1.25 ± 0.23 mg/dl. Three (25%) patients had renal allograft loss with need for initiation of HD after 30, 21 and 6 months. Two patients with renal allograft loss required insulin after 19 and 25 months. Three (25%) patients had delayed graft function. Five (41.7%) patients had renal allograft rejection at 1 month. Among the five, three had another episode of rejection at 17, 11 and 4 months. Three (25%) patients had suspected pancreatic graft rejection at POD 13, 13 and 14, which resolved with intravenous steroids. Eight (66.6%) patients had infections in the first year following transplant which included urosepsis, LRTI, tuberculosis, varicella, CMV, cellulitis, periodontal abscess, dental caries and esophagial candidiasis. Seven (58.3%) had surgical complications including pseudo aneurysm of graft pancreas, urinoma, perinephric hematoma, abdominal bleed and DIC, jejujno-jejunal anastomotic site bleed, kinked renal vein requiring re-exploration, graft pancreas fat necrosis with impending GB rupture and peritonitis, and splenic vein thrombosis requiring re-exploration. Other complications noted were incisional hernia, subacute intestinal obstruction, bilateral femoral head avascular necrosis and acute myeloid leukemia. Conclusion: The graft survival and outcomes in our institution is comparable to that of international standards. Surgical complications were noted to be higher compared to renal transplantation. SPK remains to be treatment of choice in T1DM patients with ESRD.

421.2: One Organ Procurement Organization’s 26-Year Experience With Uncontrolled DCD Donation

Introduction: Uncontrolled DCD donation is an underutilized method of procurement in the U.S., with 44% of all uncontrolled DCD donors to date being procured by one of 57 OPOs. The purpose of this study is to demonstrate that uncontrolled DCD organ donation can lead to the successful retrieval of transplantable organs and to evaluate kidney and liver transplant outcomes for recipients of organs from uncontrolled DCD donors. Methods: This is a retrospective single OPO, multi-center study. As a standard of practice the OPO routinely pursued uncontrolled DCD donors in the setting of hemodynamic instability and/or sudden cardiac arrest. The aggressive pursuit of these types of donors required the OPO to establish the following: an organizational expectation, training, active AOC oversight, a system to rapidly deploy resources, a communication plan with care-giving team members, and 24-hour organ preservation and surgical recovery support. Donor warm ischemic time was determined by the time from patient arrest to cross-clamp with most donors receiving CPR during that interval. Graft survival was determined by the Kaplan-Meier method. WIT, age, kidney PNF and DGF were further evaluated by donor Maastricht category. Results: Between 1996 and 2021, 334 kidneys, 15 livers, 2 pancreata and 1 lung was transplanted from 262 uncontrolled DCD donors. The mean donor age was 33 years (r = 0.5 – 76, sd=15). The median warm ischemic time was 44 minutes (IQR = 22 - 83). Kidney graft survival was 84% at 6 months, 78% at 1 year and 71% at 3 years. Of the 15 livers transplanted, 9 grafts implanted prior to 2010 failed within 3 months, but all 3 of the grafts implanted in 2021 are functioning at 6 months post-transplant. Two of the liver grafts are functioning at 12 years post-transplant and one is functioning at 19 years post-transplant. The lung graft is functioning at 8 years post-transplant.Conclusions: Uncontrolled DCDs provide acceptable kidney graft survival outcomes and represent a pool of organs that should be pursued for transplantation. OPOs should develop protocols to effectively recover organs from uncontrolled DCDs, particularly in light of promising new advancements in organ preservation.

P8.117: A Real-World Non-interventional Research Study of Kidney Transplant Patient Characteristics, Treatments, And Outcomes in the UK

P8.117: A Real-World Non-interventional Research Study of Kidney Transplant Patient Characteristics, Treatments, And Outcomes in the UK

316.9: Short Term Outcomes of Kidney Transplantation in HLA Sensitized Recipients: A Single-Center Study From Eastern India

316.9: Short Term Outcomes of Kidney Transplantation in HLA Sensitized Recipients: A Single-Center Study From Eastern India

Graft survival after kidney transplantation with standard versus prolonged kidney procurement time.

Background:During kidney procurement, after ice removal, kidneys located in the retroperitoneum are at risk for rewarming owing to the time taken to retrieve other abdominal and thoracic organs, which may lead to poorer outcomes. The purpose of this study was to evaluate the impact of prolonged kidney procurement time (PKP) on outcomes of kidney transplantation performed at the Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada.Methods:We retrospectively reviewed the cases of all adult (age ≥ 18 yr) patients who underwent kidney transplantation at the Queen Elizabeth II Health Sciences Centre between Jan. 1, 2010, and Dec. 31, 2015. We included all patients who received kidney transplants from deceased donors with a minimum follow-up period of 3 years. We defined PKP as more than 65 minutes from aortic cross-clamp to final organ extraction, and standard procurement time (SP) as 65 minutes or less.Results:Among the 455 transplantation procedures performed during the study period, we reviewed the cases of 145 patients who received kidneys from Nova Scotian donors and were followed in Nova Scotia. No statistically significant differences were seen in outcomes between kidney-only (n = 46) and multiorgan (n = 99) procurement, although more organs from kidney-only donors than multiorgan donors had a Kidney Donor Profile Index score greater than 50% (32 [69.6%] v. 48 [48.5%], p < 0.01). Compared to the SP group (n = 115), the PKP group (n = 30) had a higher rate of 30-day graft loss (6.7% v. 0.0%, p < 0.01), a higher incidence of de novo formation of donor-specific antibodies (3 [10.0%] v. 1 [0.9%], p < 0.01) and a lower 5-year graft survival rate (90.0% v. 97.4%, p = 0.03). Left kidneys remained 11 minutes longer on the donor than right kidneys when multiorgan procurement was performed (p < 0.01), and their 5-year survival rate was significantly lower than that of right kidneys (p = 0.03).Conclusion:Procurement times longer than 65 minutes may be associated with poorer outcomes after kidney transplantation. Measures to reduce kidney exposure to rewarming during procurement may improve long-term outcomes.

332.9: Utility of Color Doppler Ultrasound and Contrast Enhanced Ultrasound in Predicting Kidney Transplantation Outcome: A Monocentric Study

332.9: Utility of Color Doppler Ultrasound and Contrast Enhanced Ultrasound in Predicting Kidney Transplantation Outcome: A Monocentric Study

342.1: Comparable Kidney Transplant Outcomes in Selected Patients With a BMI ≥40: A Personalized Medicine Approach To Recipient Selection

Introduction: Kidney transplantation confers a survival benefit compared with dialysis in most studies of obese patients. Yet, many transplant centers decline patients with a body mass index (BMI) ≥40 kg/m2. Our practice relies on computed tomography imaging to evaluate iliac depth and pelvic angle to assess candidacy (see Figure 1). Our aim was to evaluate post-transplant outcomes including survival in patients according to recipient BMI. Methods: We performed a single-center retrospective review of adult kidney transplant alone recipients comparing BMI ≥40 patients (n=84, BMI =42±2 kg/m2) to a matched BMI <40 cohort (n=84, BMI =28±5 kg/m2). Patients were matched for recipient age, gender, race, presence of diabetes, and donor type (living vs. deceased). Results: BMI ≥40 patients were on dialysis longer pre-transplant (5.2±3.2 years vs. 4.1±3.5 years, p=0.03) and received lower kidney donor profile index (KDPI) kidneys (40±25% vs. 53±26%, p=0.003) compared to lower BMI patients. There were no significant differences in prevalence of delayed graft function, reoperations, readmissions, wound complications, patient survival, or renal function at 1 year according to serum creatinine and eGFR. Long-term graft survival was higher for BMI ≥40 patients, including after adjusting for KDPI (BMI ≥40: aHR=1.79, 95% CI=1.09-2.9) (see Figure 2). BMI ≥40 patients had similar weight gain and BMI change in the first year post-transplant (delta weight: BMI ≥40 + 2.5±9.1 kg vs. BMI <40 + 3.0±8.0 kg, p=0.74; delta BMI: BMI ≥40 + 0.9±3.3 vs. BMI <40 + 1.1±3.2, p=0.59). BMI ≥40 patients had a higher mean HbA1c level (6.9±1.7% vs. 5.9±1.4%, p=0.003) at one year post-transplant. Conclusions: Overall patient survival and complications after kidney transplantation were comparable in BMI ≥40 patients compared to a matched cohort with lower BMI with improved long-term graft survival in the obese patients. BMI-based exclusion criteria for kidney transplantation should be reexamined in favor of a more individualized approach.

P16.33: Comparison of Kidney Transplant Outcomes Before and After Coronavirus Disease 2019 Pandemic: A Single-Institution Experience

P16.33: Comparison of Kidney Transplant Outcomes Before and After Coronavirus Disease 2019 Pandemic: A Single-Institution Experience

401.1: Impact of HLA-A,B DR and DQ on Living Kidney Transplant Outcomes in the Tacrolimus/MMF Era: An Artificial Intelligence Approach

Introduction: One of the biological barriers that can impact outcomes among Living donor kidney transplantation is HLA mismatch. The aim of our study is to assess the effect of HLA mismatches on acute rejection rates and graft survival in the Tacrolimus era. Moreover, to assess factors affecting survival. Methodology: All Living donor kidney transplant patients registered in UNOS database between 01/01/2005 and 01/12/2019 were retrospectively reviewed. Inclusion criteria: Living donor transplant recipients that were discharged on Tacrolimus/Mycophenolate Mofetil. Exclusion criteria: multiple organ transplants, previous kidney transplants, recipient age<18 years old, deceased donor transplants, missing data about induction therapy, missing HLA mismatch or ABO incompatible transplant. We used double-selection lasso (least absolute shrinkage and selection operator) logistic regression model to assess for acute rejection rates at one-year post-transplant. Variables of interest were HLA-A,B,DR and DQ mismatch. Variables Lasso selected from were: recipient characteristics (age, sex, BMI, ethnicity, diabetes, recipient/donor CMV status, pre-transplant dialysis), donor characteristics (age,ethnicity, diabetes and hypertension) and transplant characteristics (induction therapy, steroid intake, cold ischemia time, delayed graft function, PRA). Acute rejection was defined as biopsy proven or clinically suspected rejection. For survival analysis, we fit a penalised Cox model after choosing best alpha. Cross-validated grid-search was used to evaluate the best alpha. The variables included in the penalised cox model donor, recipient and transplant factors plus HLA mismatches. Results: 28,736 patients were included in our study. Worse acute rejection rates at one-year post-transplant were noted with incremental increase in HLA-DQ (Two HLA-DQ: OR=1.29, P<0.01, 95%CI:1.08-1.54; One HLA DQ:OR=1.22,P=0.01, 95%CI:1.05-1.44), HLA-DR mismatches (Two HLA-DR: OR=1.85, P<0.01, 95%CI:1.48-2.31; One HLA-DR: OR=1.51,p<0.01, 95%CI:1.23-1.85),HLA-B mismatches(Two HLA-B OR=1.33, P=0.01,95%CI:1.05-1.69; One HLA-B mismatch: OR=1.21,P=0.09) and HLA-A mismatch (OR:1.19, P<0.01). In the penalized cox regression model, None of the HLA types (A,B,DR or DQ) were associated with worse graft survival (P>0.05 for every type). The factors that were associated with worse outcomes are: Recipient black ethnicity (HR 1.2, P<0.01, 95%CI:1.10-1.31); delayed graft function (HR=1.54, p<0.01, 95%CI:1.31-1.81), pre-transplant dialysis (HR=1.19,P<0.01, 95%CI:1.12-1.26) and donor Black ethnicity(HR=1.21, P<0.01, 95%CI:1.10-1.33). Conclusion: HLA-DQ, DR,B and A mismatches play a vital role in the occurrence of acute rejection among Living donor kidney transplant recipients. However, HLA mismatches have no significant effect on graft survival. Delayed graft function, pre-transplant dialysis recipient and donor black ethnicity, play an important role in determining graft survival.

Medium and Long-Term Clinical Outcomes of Kidney Transplantation in Patients With Prune Belly Syndrome: A Single-Centre Experience

To present the medium and long-term outcomes of kidney transplantation performed in patients with Prune Belly Syndrome (PBS) which is one of the congenital anomalies of the kidney and urinary tract (CAKUT). Thirteen kidney transplantations were performed in nine patients with PBS from January 1994 to December 2020. Demographics, surgical features, graft and patient survival rates were analyzed. Survival outcomes was compared with 106 age- and donor-type matched controls who underwent transplantation because of nonurological causes. The median ages of PBS patients at the time of first and second transplantation were 19 and 34 years old, respectively. One patient had postoperative Clavien grade 3a complication. Eight of 13 transplants are still functional at the last follow-up. Eight patients underwent pretransplant urological operations in preparation for kidney transplantation, while 4 patients underwent urological operations in the post-transplant period. Graft survival for PBS transplants at 5, 10, and 15 years were 90.9%, 57.7%, and 38.5%, respectively. Graft survival for control cohort at 5, 10, and 15 years were 89.9%, 80%, and 74%, respectively. The patient and graft survival rates were similar between PBS and control groups (P=.449, P=.134, respectively). This single-center study showed that the medium-term graft survival rates in patients with PBS are encouraging and comparable to non-CAKUT transplant patients, however long-term graft survival rates were found to be proportionally inferior. To help determine the reasons for long-term transplant kidney function deterioration and how to improve them we suggest that multicenter international collaboration will be needed.