Kidney Week

Abstract: SA-PO812

Validation of Adjusted Donor Age: A Tool to Support Deceased-Donor Kidney Organ Acceptance at a Eurotransplant Centre

Session Information

• Transplantation: Clinical - Pretransplant Assessment and Living Donors
  November 05, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
  Abstract Time: 10:00 AM - 12:00 PM

Category: Transplantation

• 2002 Transplantation: Clinical

Authors

• Mahler, Christoph Friedrich, Universitatsklinikum Heidelberg Nierenzentrum Heidelberg eV, Heidelberg, Baden-Württemberg, Germany

Christoph Friedrich Mahler,

• Ashby, Damien, Imperial College London, London, London, United Kingdom

Damien Ashby,

• Nusshag, Christian, Universitatsklinikum Heidelberg Nierenzentrum Heidelberg eV, Heidelberg, Baden-Württemberg, Germany

Christian Nusshag,

• Speer, Claudius, Universitatsklinikum Heidelberg Nierenzentrum Heidelberg eV, Heidelberg, Baden-Württemberg, Germany

Claudius Speer,

• Benning, Louise, Universitatsklinikum Heidelberg Nierenzentrum Heidelberg eV, Heidelberg, Baden-Württemberg, Germany

Louise Benning,

• Göth, Daniel, Universitatsklinikum Heidelberg Nierenzentrum Heidelberg eV, Heidelberg, Baden-Württemberg, Germany

Daniel Göth,

• Schaier, Matthias, Universitatsklinikum Heidelberg Nierenzentrum Heidelberg eV, Heidelberg, Baden-Württemberg, Germany

Matthias Schaier,

• Mehrabi, Arianeb, Universitatsklinikum Heidelberg Chirurgische Klinik, Heidelberg, Baden-Württemberg, Germany

Arianeb Mehrabi,

• Zeier, Martin G., Universitatsklinikum Heidelberg Nierenzentrum Heidelberg eV, Heidelberg, Baden-Württemberg, Germany

Martin G. Zeier,

• Morath, Christian, Universitatsklinikum Heidelberg Nierenzentrum Heidelberg eV, Heidelberg, Baden-Württemberg, Germany

Christian Morath,

• Kälble, Florian, Universitatsklinikum Heidelberg Nierenzentrum Heidelberg eV, Heidelberg, Baden-Württemberg, Germany

Florian Kälble,

Background

In view of the organ donor shortage and growing waiting lists for kidney transplantation an optimal acceptance strategy for deceased-donor kidney offers is paramount. However, acceptance decisions are challenging not the least because current tools for assessment of kidney offers, e.g. KDRI/KDPI (Kidney Donor Risk Index/Kidney Donor Profile Index) are limited and most transplant centres lack clear criteria.

Methods

To meet the multi-morbid patient population at a London transplant centre Adjusted donor age (ADA) was developed as a tool to support organ acceptance decision making in deceased-donor kidney transplantation. Thereby offers are divided according to risk into quintiles (A - E). (A - C favourable, D moderate, E unfavourable). These quintiles are associated with the adjusted donor age. Underlying is the real donor age, adjusted for associated risk factors and the immunological constellation.

Results

Here, we evaluate whether ADA can be applied at a Eurotransplant Centre in Germany to assess organ quality and guide acceptance decisions. For this monocentre validation study we included 463 deceased-donor kidney organ offers of which 173 were accepted and transplanted. We followed organ recipients for three months after transplantation and measured eGFR as the primary outcome parameter. Statistical analysis revealed that indeed higher ADA quintile was associated with poorer transplant outcome. The three-month eGFR was strongly associated with ADA (r=0.56) in patients with functioning graft and decreased with higher ADA quintiles (A: 64, B: 60, C: 49, D: 37 and E: 28 mL/min/1.73m²).

Conclusion

Taken together our study suggests that ADA can be applied at a Eurotransplant centre as a simple tool to characterise deceased-donor kidney organ offers. ADA may facilitate acceptance decision making and help to distinguish organs with favourable outcomes from ones with high probability of poor graft function.