ABSTRACT
Purpose: The demand for kidney transplant continues to rise, and limited supply has encouraged acceptance of marginal donor organs, such as those at risk for acute kidney injury (AKI). We evaluated the utilization of such organs (defined as donation after cardiac death, pediatric donors, kidneys with a cold ischemic time >24 hrs, terminal serum creatinine (SCr) >2mg/dL or rising SCr with decreasing urine output at donation) at our center who were discharged on belatacept based maintenance immunosuppression with mycophenolate and steroids (BBMS). Method(s): This retrospective, descriptive study examined kidney transplant recipients (KTR) who received AKI organs and were discharged on BBMS between 1/2019-4/2021. Primary outcome assessed graft function and rejection at 6 & 12 months (mos) post-transplant (txp). Secondary outcomes evaluated graft failure, mortality, infection, DSA & changes to BBMS. All outcomes were evaluated at 1yr if records were available. Result(s): 68 KTR w/1 yr results & 52 w/6 mo results on BBMS were included. Baseline characteristics (Table 1) show most KTR received a DCD or en bloc organ and lymphocyte depleting induction. Mean eGFR improved from 1 to 6 mo post-txp and was stable through 1yr. Episodes of biopsy proven rejection were more common during the first 6mos post-txp. There were 2 deaths during the study period, due to COVID, and no graft failures. Twelve KTR developed DSA. There were 21 KTR with CMV viremia, mostly in moderate risk group, & 12 with BK viremia. Table 4 shows changes to BBMS occurred in 32 KTR. Most KTR required multiple BBMS changes with most common dose adjustments to mycophenolate due to leukopenia or neutropenia. Conclusion(s): Utilization of AKI organs with BBMS in KTR at our center resulted in no graft failures & sustained eGFR despite more rejection episodes during the first 6mos post-txp. Although 32 KTR had changes to BBMS, only 5 KTR had rejection following a change. Incidence of CMV was common but did not impact KTR outcomes. Overall, BBMS could be a promising option in AKI organs to avoid nephrotoxicity associated with CNI based regimens. These findings suggest the need to further evaluate the impact of long-term outcomes associated with changes made to BBMS in AKI donor organs.
ABSTRACT
Purpose: Mortality secondary to COVID-19 infection is significantly higher in solid organ transplant recipients compared to the general population. Limited data exists evaluating the impact COVID has had on mortality compared to other causes, with even less data specific to the Mountain West region of the United States. This quality improvement project seeks to evaluate trends in patient mortality at a center in the Mountain West region before and after the COVID pandemic in kidney transplant recipients (KTR). Method(s): This is a retrospective single-center analysis of all adult KTRs who underwent transplant between January 1999 and July 2021 and subsequently died between January 2015 and July 2021, assessing the change in mortality trends with the advent of the COVID-19 pandemic. Additional endpoints include time from transplant to death, graft status at time of death, and COVID vaccination status. Data collection included UNOS data reports as well as manual electronic medical record review. Result(s): One-hundred and seventy-two KTRs were included with baseline characteristics described in Table 1. Prior to the COVID-19 pandemic, the most common etiology of mortality was cardiovascular cause with a median of 18% mortality (see Table 1). Of those who died in 2020, 33% were secondary to COVID-19 leading to a 174% increase in cumulative patient deaths compared to the year prior (23 vs 40 patient deaths in 2019 vs 2020;see Table 1 and Figure 1). Of those who died secondary to COVID, none had received the COVID-19 vaccine. Conclusion(s): COVID-19 pneumonia and its associated complications have led to an increase in and earlier mortality prior to vaccination implementation, changing the mortality landscape in KTRs. Further investigation is needed to elucidate non- COVID related changes in mortality and patient outcomes in the ongoing COVID pandemic.