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Master Thesis

Résultats des transplantations rénales réalisées à partir de donneurs à critères élargis : expérience multicentrique sur 10 années de greffe

Abstract : Background: Since 2002, allocation policies have changed to allow transplantation using expanded criteria donors (ECD). The aim of this thesis is to assess the outcomes of transplantation using kidneys from expanded criteria donor.
Methods: Patients who received kidney allografts on three transplantation centers in Paris between January 1, 2004 and January 1, 2011, were included in this study (N=1613). The type of donor was defined as standard (SCD) or expanded criteria donors (ECD). Clinical, biological, histological parameters and the presence of circulating donor-specific anti-HLA antibodies were screened for all the recipients at the time of transplantation. The main outcome was the kidney allograft loss. Results were replicated in an external validation cohort of 1150 kidneys recipients (Toulouse).
Results: The 7-years kidney allograft survival was 80.7% for ECD recipients and 90.9% for SCD recipients (p<0.0001). We identified two independent factors associated with kidney allograft loss after adjustment for clinical parameters, baseline biopsy results and immunological parameters at day of transplantation: expanded criteria donor (hazard ratio, 2,628; 95% [CI], 1,929 - 3,579; p<0.0001), and the presence of circulating donor-specific anti-HLA antibodies at the day of transplantation (hazard ratio, 3.623; 95% [CI], 2.623 - 5.023; p<0.0001). Recipients with expanded criteria kidneys had a 39.1% improvement of 7-year kidney allograft survival when they were screened and transplanted without circulating donor-specific anti-HLA antibodies.
Conclusion: The excellent kidney allograft survival of ECD kidneys incites allocation policies of these kidneys in particular if the recipient has no DSA at the time of transplantation.
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Master Thesis
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Olivier Aubert. Résultats des transplantations rénales réalisées à partir de donneurs à critères élargis : expérience multicentrique sur 10 années de greffe. Médecine humaine et pathologie. 2014. ⟨dumas-01121745⟩

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