MO973PRE-IMPLANTATION BIOPSY FINDINGS AND IMPACT ON LIVE DONOR KIDNEY TRANSPLANT RECIPIENT OUTCOMES - A SINGLE CENTRE STUDY

Background and Aims Live donor kidney transplantation remains the mainstay of renal replacement therapy in Sri Lanka. The basic universal pre surgical investigations, human leucocyte antigen (HLA) matching and cross matching are routinely performed, however due to high rates chronic kidney disease (CKD) as well as increasing numbers of, chronic kidney disease unknown etiology (CKDu) in Sri Lanka, there is a possibility of subclinical kidney disease being present in donor kidneys which go undiagnosed. A study of pre-implantation biopsy along with follow-up outcomes of kidney transplant recipients is conducted to identify presence of subclinical kidney disease in a Sri Lankan cohort of patients. Method We collected thirty three (33) live donor pre-implantation biopsies during 4 consecutive months in 2020 as well as 1 month follow-up data. This is part of an ongoing follow-up study which is conducted at National Hospital, Kandy, Sri Lanka. Results Thirty three (33) live donor recipients and their pre-implantation renal biopsy samples were studied. The mean age of the study participants’ was 37.6 (SD 12.5, range 13 - 59) years. A predominant number of male patients were in the sample (n=21, 63.6%). Underlying aetiology of end stage renal disease (ESRD), was predominantly due to chronic hypertension (39.3%; n=13) and diabetic kidney disease (21.2%, n=7) accounting for nearly 60% of the study participants. Among the 33 live donors 1st degree, 2nd degree and non-relative donors were 54.4% (n=18), 18.2% (n=6) and 27.3% (n=9) respectively. Pre-implantation renal biopsy results reported 36.4% (n=12) with abnormal biopsy findings including chronic interstitial nephritis (n=4, 12.1%), interstitial fibrosis (n=6, 18.18%) and acute tubular necrosis (n=2, 6%). Follow-up revealed delayed graft function occurring in 18.2% (n=6) of recipients with 50% (n=3) of them showing abnormalities in the pre-operative donor biopsy sample. At one month follow-up, 48.5% (n=16) reported complications which included graft failure 3% (n=1), all-cause mortality 3% (n=1), acute rejection 39.4% (n=13) and infections 24.2% (n=8). Overall, 37.5% (n=6) of these recipients had abnormal donor biopsy findings, however no significant statistical association was identified. Conclusion Our study identified subclinical kidney disease in donor kidneys despite standard pre-transplant screening. Even though, statistically not significant, recipients with abnormal pre-implantation biopsy findings had adverse short term post-transplant complications.

P1661EVOLUTION OF RENAL FUNCTION IN RENAL TRANSPLANTED DONORS PATIENTS IN ASYSTOLE TYPE II. IS THERE A CORRELATION BETWEEN HISTOPATHOLOGY PARAMETERS OF THE DONOR BIOPSY AND THE GRAFT SURVIVAL? EXPERIENCE IN OUR CENTER

Background and Aims With the aim of increasing the number of kidney transplant donors (RT), the use of organs from cadaver donors in asystole (DA) type II of Maastricht has been enhanced in recent years.The important ischemia that this type of donation entails makes it especially complex, resulting in a higher incidence of delayed renal function and non-primary graft function, compared to the TR from donor in brain death.We present our experience with the Mastricht DA type II TR since the beginning of our program in 2013 Method 108 patients with type II performed between January 2010 and June 2019, median follow-up 30 months. Results : mean age of the donor 42 years, 65% blood group A, mean Cr at the first month of 3 mg/dl, at the 3rd month of 1.9 mg/dl and currently 1.6 mg/dl. Mean ange of the receptor 46 years, time on dialysis 30 months, 1st transplant all, except 1. PRAc pre TR was < 25%, initial immunosuppression with thymoglobulin, steroids, mycophenolate, and delayed introduction of tacrolimus. 10% never function; 73.5% delayed renal function. 7.2% acute rejection. Survivors of the 1st, 3rd and 5th year recipients are 98%, 98% and 86% respectively. In a innovative way, it has been registered the correlation between histopathology parameters of the donor biopsy and the graft survival. Conclusion RT with type II DA has more incidence of delayd renal function and non-primarygraft function, however results in survival and kidney function in our center are very acceptable, comparable to donors in brain death.