SP794
IMPACT OF DECEASED DONOR CORTICOSTEROID TREATMENT ON KIDNEY TRANSPLANT OUTCOME Free

INTRODUCTION AND AIMS: With the aim of overcoming consequences of brain death including hemodynamic disorders, hormonal imbalance and inflammation, donors are subject to various therapy options that are an important part of the strategy for improvement trasplantation outcome. The aim of the study was to examine the influence of a single dose of methylprednisolone (MP) immediately after donor brain death on delayed graft function (DGF), as well as kidney allograft function during the first posttransplant year.

METHODS: The single center prospective study involved selected group of 37 deceased donors from January 1st 2010 to Decembar 31st 2012, maintananed shorter than 24 hour without cardiac arrest and with preserved renal function on admission. Donors were maintained by standard protocol (Group 1) or received 500 mg MP in addition to standard therapy (Group 2). Usage of dopamine was allowed in both groups. The study also included 60 adult kidney transplant recipients (KTR) transplanted in the local center with panel reactive antibodies <30% and without diabetes. The first group of 30 KTR (21 male, mean age 45.3±10.4 years) were allocated organs from 21 deceased donors (mean age 53.3±14.2 years) treated by the standard protocol and the second group of 30 KTR (20 male, mean age 49.0±10.2 years) received allografts from 16 deceased donors (mean age 50.7±15.3 years) who had been given MP. Allograft function was monitored for a year after transplantation by determining the concentration of serum creatinine, creatinine clearance and proteinuria. The association between donor and recipient variables and clinical course after transplantation was examined by logistic as well as linear regression analysis.

RESULTS: The demographic, laboratory and clinical data of the two donor groups were similar among those received standard protocol or MP, except that the subjects who received MP had significantly higher mean arterial pressure than donors of Group 1 (100.0±15.5 vs. 87.4±15.3 mmHg; p<0.01). The groups of KTR did not differ in terms of HLA matching, demographic and clinical characteristics. Univariate logistic regression showed that treatment of the donors with MP was without significant impact on DGF frequency. However, KTR of the second group had better allograft function than those in the first group during the entire follow up period and the difference in creatinine clearance became statistically significant at the end of the first posttransplant year (68.10± 27.85 vs. 52.46±14.48ml/min; p<0.05). Linear regression analysis revealed that MP tretment positively affected creatinine clearance at 12th posttransplant month (p<0.05), while donor age (p<0.01), female gender (p<0.05), marginal donor status (p<0.01) and acute rejection episodes (p<0.05) adversely affected creatinine clearance at 12th posttransplant month.

CONCLUSIONS: MP treatment contributes to organ quality with a consequently better kidney allograft function during the first posttransplant year