Results of the second decade of the Trans-Atlantic Airlift for renal transplantation recipients from the Dutch Antilles: an unique program comes of age

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Z.A. Choudry, H. Peters-Sengers, N. Ajubi, W. de Velter, R. Kock, N.M. Lardy, N.C van der Weerd, J.J.H. van der Heijde, K.A.M.I. van der Pant, M.M. Idu, F.J. Bemelman

Chair(s): dr. M.A.C.J. Gelens

Thursday 9 march 2017

12:30 - 12:45h

Categories: Poster - Klinisch

Parallel session: Postersessie - Klinisch 4

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Background:
The prevalence of end-stage renal disease in the Dutch Caribbean is twice as high compared to the Netherlands.  In 1998, the St. Elisabeth Hospital and in 2003 the Dr. Horacio E. Oduber Hospital in Aruba, started a unique trans-Atlantic collaboration with the Academic Medical Center in Amsterdam, the Netherlands, and the Eurotransplant Foundation. This study is an analysis of the early renal outcome of this trans-Atlantic program from April 2007 until August 2016. From April 2007 two measures were taken: 1) all patients received induction therapy with basiliximab, and 2) only brain-death donors in case of deceased donors were accepted.

Methods:
In 88 consecutive transplantations performed between April 2007 and August 2016, 3 month graft survival, primary non function and rejection rate at 3 months were studied. These were compared with 39 transplantation between April 1997 and end of March 2007.

Results:
Sixty patients received a first and 3 received a second deceased donor transplant, and 24 patients received a first and 1 a second living donor transplantation. Mean recipient age of deceased and living donors was 52 years (SD 13) and 48 years (SD 15) respectively. Original disease was hypertension (22%), diabetes 17%, glomerulonephritis (6.3%) cystic kidney disease (6.3%). Dialysis vintage of deceased and living donors was 72 months (SD 30) and 40 months (SD 23) respectively. Donor age was 52 years (SD 12) and 52 years (SD 14) for deceased and living donors respectively. Median cumulative HLA mismatches were 3 (IQR 2-4) in deceased and 3 (IQR 3-4) in living donors. Cold Ischemic time was 24.2 hours (SD 8.6) in deceased and  2.9 (0.6) hours in living donors. Primary non-function rate and delayed graft function was 3.2% and 31% in deceased, and  0% and 12% in living donors respectively. Rejection rate at 3 months was 12.7% in deceased, and 12% in living donors. Mean eGFR of deceased donor kidneys-with-function at 3 months was 51 (SD 25), and eGFR was 51 (SD 14) in living donor kidneys. Graft survival in deceased kidneys after April 2007 was higher (93.7% vs. 82.1%, p=0.063). Graft survival in living donor kidneys was 100% in both eras. In deceased donor kidneys, primary non-function rate declined after April 2007 (10.5% to 3.2%, p=0.194), delayed graft function was similar, and rejection rate within 3 months declined (23% to 13%, p=0.184).

Conclusion:
These data outline the success of the Trans-Atlantic program. This success is achieved despite prolonged cold ischemia times. Routine machine perfusion of all deceased donor kidneys might have a role. Although not significantly, primary non-function and rejection rates seem to have decreased. Long-term follow up results of the program are currently under investigation.