EVALUATION OF ONE YEAR OUTCOMES OF RENAL TRANSPLANT RECIPIENTS OF EXPANDED CRITERIA LIVING DONOR

Introduction:

Kidney transplantation improves quality of life and reduces mortality risk for ESRD patients compared to maintenance hemodialysis (MHD), making it the treatment of choice. Efforts to increase organ availability include using 'Expanded Criteria Living Donors' (ECD).

Methods:

This prospective observational study included all patients who underwent transplantation between August 2022 and July 2023. Patients were grouped into ECD ( Donor age >60 yrs or risk factors such as Hypertension; Diabetes Mellitus with albuminuria <30mg/day no Left Ventricular Hypertrophy, no Retinopathy; Obesity: BMI>30 kg/m2; Anatomical variation such as dual renal arteries) and SCD (standard criteria donor) groups. Outcomes at one year for recipients and donors were compared such as graft function and graft surviva, graft rejection (clinical or histological) and donor outcome comparison between both groups.

Results:

A total of 131 patients were enrolled: 71 in the SCD group and 60 in the ECD group. There were no significant differences in baseline characteristics (age, BMI, comorbidities, HD vintage, TIT, ABOi, and received induction therapy) between the groups; however, differences were in HLA mismatch >6 and the underlying disease, such as diabetic kidney disease. All recipients were on triple immunosuppressants, including tacrolimus, mycophenolate mofetil, and prednisolone. Significant differences were found in donor mean age, BMI, BP, LKDPI, eGFR, creatinine, and proteinuria.

Outcomes at 3, 6, and 12 months showed that eGFR was higher in the SCD group, with a mean difference of 6±2 ml/min (P value 0.08), though this was not statistically significant. Hemoglobin was higher in the SCD group, but these differences were not sustained at 12 months. No significant differences were found in UPCR values, rejection episodes ( p value 0.94), TMA, UTI, BKV/CMV infection, or BKV nephropathy. A subgroup analysis of outcomes for recipients who received a kidney from donors with each comorbidity was performed. Age-matched cohorts were compared for donors with diabetes mellitus (DM); no significant difference in outcomes was found.

In the Expanded Criteria Donor (ECD) group, there was a significant difference in baseline blood pressure (BP) and BP at 1 year (P-value <0.01). Similarly, there was a significant difference in estimated glomerular filtration rate (eGFR) and HbA1c at baseline and at 1 year. Additionally, the risk of ESRD at 15 years was significantly higher in the ECD group. However, there was no difference in the lifetime risk of ESRD between the groups.

Conclusions:

Our study shows no significant difference in short-term outcomes for ECD recipients compared to SCD. The lifetime ESRD risk for ECD donors is not significantly increased. In our country, where deceased donor pools are limited, Renal transplant with ECD can be life-saving for ESRD patients without significantly affecting donor health.

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.