Journal Article

Shipping donor kidneys within Eurotransplant: outcomes after renal transplantation in a single-centre cohort study

Karl Martin Wissing, Nilufer Broeders, Annick Massart, Mireille Kianda, Lidia Ghisdal, Anne Lemy, Anh Dung Hoang, Dimitri Mikhalski, Vincent Donckier, Judith Racapé, Pierre Vereerstraeten, Jan de Boer and Daniel Abramowicz

in Nephrology Dialysis Transplantation

Published on behalf of European Renal Association - European Dialysis and Transplant Assoc

Volume 27, issue 9, pages 3638-3644
Published in print September 2012 | ISSN: 0931-0509
Published online May 2012 | e-ISSN: 1460-2385 | DOI: http://dx.doi.org/10.1093/ndt/gfs142
Shipping donor kidneys within Eurotransplant: outcomes after renal transplantation in a single-centre cohort study

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Background

Shipment of organs during the allocation process aims to improve human leucocyte antigen (HLA) matching but can also have a detrimental effect by prolonging cold ischaemia. The overall effect of organ exchange on post-transplant outcomes in the Eurotransplant (ET) region has not been investigated.

Methods

This is a retrospective single-centre cohort study to investigate the effect of shipment of renal allografts on cold ischaemia times and the incidence of acute rejection (AR) and graft survival in 661 transplantations of deceased donor kidneys.

Results

Forty-six per cent (N = 301) of the patients received a locally procured and 54% (N = 360) a shipped donor kidney. Locally procured donors tended to be older, more often hypertensive and had less frequently died from trauma. Recipients of shipped kidneys were at higher immunological risk, being younger, more frequently retransplanted and immunized against HLA antigens. Shipped kidneys had a 2.2-h prolongation of cold ischaemia time (18.0 versus 20.2 h; P < 0.0001) but significantly less HLA A, B and DR mismatches (2.20 versus 2.84; P < 0.0001). Recipients of shipped kidneys had an increased incidence of first-year AR [19 versus 13%; odds ratio 1.62 (1.06–2.49); P = 0.026] and death-censored graft loss [hazard ratio 1.6 (1.1–2.4); P = 0.01] that was no longer statistically significant after adjustments for risk factors by multivariable modelling.

Conclusions

Shipment of kidneys in the ET region is associated with a modest increase in cold ischaemia time and significantly better HLA matching. This allows for successful transplantation of higher risk patients with no significant penalty with regard to AR rates or death-censored graft survival.

Keywords: acute rejection; cold ischaemia time; death-censored graft survival; kidney transplantation; organ allocation

Journal Article.  4545 words.  Illustrated.

Subjects: Nephrology

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