Macroscopic arteriosclerosis of the renal artery is associated with organ discard and primary non-function, but not with graft function or long term survival of 50+ deceased donor kidneys

C. Moers, A. Keijbeck, R. Veenstra, R.A. Pol, C. Konijn, N. Jansen, H. van Goor, C. Peutz-Kootstra, A.J. Hoitsma

Wednesday 13 march 2019

14:26 - 14:28h at Mauritszaal

Categories: Klinisch, Parallelsessie

Parallel session: Parallelsessie IV - Klinisch I

Background: The average deceased donor today is significantly older than donors were a few decades ago. Older donors have more arteriosclerosis of the renal artery. During organ retrieval, surgeons estimate the degree of arteriosclerosis and this plays an important role in decisions on organ acceptance. Our study aimed to elucidate the association between macroscopic renal artery arteriosclerosis, donor kidney discard and transplant outcome. We also investigated whether assessment of macroscopic arteriosclerosis correlated with histological evidence of intrarenal arteriosclerosis.

Methods: We selected all renal transplants between 01-01-2000 and 31-12-2015, from deceased donors aged 50 years and older, carried out in any of the 8 transplant centres in The Netherlands. We included only those for which data on renal artery arteriosclerosis were available (n=2,239). Donors were either DBD (n=1,107) or controlled DCD (n=1,132). The association between arteriosclerosis and kidney discard, the relation between arteriosclerosis and outcome and the correlation between macroscopic and microscopic arteriosclerosis were explored by means of univariable and multivariable analyses.

Results: Median donor age was 60 (range 50-82). Degree of macroscopic arteriosclerosis was either none, mild, moderate, or massive. Macroscopic arteriosclerosis was independently associated with kidney discard (OR 1.36 95% CI 1.02-1.80 p=0.03). Arteriosclerosis was not significantly associated with delayed graft function (OR 1.16 95% CI 0.94-1.43 p=0.16), eGFR 1 year post-transplant (B 0.58 95% CI -2.07-3.22 p=0.67) and long term death censored graft survival (HR 1.07 95% CI 0.86-1.33 p=0.55). There was a significant association between mild arteriosclerosis and primary non-function (OR 2.14 95% CI 1.19-3.84 p=0.01). However, higher degrees of arteriosclerosis were not a risk factor for primary non-function. There was no correlation between macroscopic and histological parameters of arteriosclerosis.

Conclusions: Macroscopic arteriosclerosis of the renal artery was somewhat associated with more primary non-function. However, there was no effect on delayed graft function, eGFR at 1 year, or long term graft survival. This study suggests that, if a 50+ deceased donor kidney shows immediate or delayed function, renal artery arteriosclerosis will not negatively affect long term transplant outcome. Given these data, we feel that kidney discard based on macroscopic assessment of arteriosclerosis should be discouraged.