Extended Criteria Kidney Donors in Canada-Canada DONATE
CCCF ePoster library. D'Aragon F. Nov 7, 2018; 233438
Frederick D'Aragon
Frederick D'Aragon
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Abstract
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INTRODUCTION: A critical shortage of kidneys for transplantation constantly pushes the transplant community to consider extended criteria donors (ECDs). ECD kidneys are more prone to delayed graft function and rejection. Optimizing donor management might mitigate these risks.

OBJECTIVES: The primary objective of this study is to describe the management of ECDs in the context of the Canada-DONATE national cohort study. A secondary objective is to compare the care of ECDs and standard criteria donors (SCDs) from whom kidneys are ultimately recovered.

METHODS: This study is a secondary analysis of the Canada-DONATE cohort study (Aug/2015 – July/2018): a prospective study of deceased donor management practices over 12 months in 34 hospitals. The DONATE study enrolled 635 consecutive adults for whom there was consent for organ donation after a neurological determination of death (NDD) (N=416) or a circulatory determination of death (DCD) (N=219). We excluded from this analysis donors for which kidney donation was ruled out before or during consent (N=40). We classified all potential donors on the final day of donor management as ECD or SCD, applying the United Network of Organ Sharing definition of ECDs (age ≥60 years; or age >50 years old plus at least 2 of: history of hypertension, serum creatinine > 132.7 mmol/L or death from stroke). We describe current organ donor management practices related to specific interventions perceived to be associated with favorable renal donation outcomes. Therapeutic hypothermia is defined as the initiation of cooling procedure after the declaration of neurological death. We analysed the use of any temperature management initiated at least one day from the time of consent up to the time of organ donation. We present unadjusted data, compared using Chi-square analyses and Student-T or Mann-Whitney U tests.

RESULTS: This study includes 595 donors: 229 (38.5%) ECDs and 366 (61.5%) SCDs.(Table 1) Of these, 388 proceeded to kidney donation. Beside thyroid administration and mean arterial pressure attained there was no significant difference in care between ECD and SCD kidney donors.(Table 2). Hypothermia protocol only for the purpose of donor management; was infrequently ordered.

 CONCLUSION: ECDs represent a significant proportion of potential and actual kidney donors. Despite preliminary findings that mild hypothermia decreases the rate of delayed graft function in recipients, hypothermia protocols were infrequently applied. Care of ECD and SCD kidney donors differed with respect to mean arterial pressure and thyroid hormone. Altough uncertain, these findings may be related to the management of other organs recovered in SCD compared to ECD, as donors are often considered for multiple organs.

 

 


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