P1671CHALLENGES AND OUTCOMES OF A KIDNEY TRANSPLANT PROGRAM IN LOW INCOME SETTINGS - THE EXPERIENCE OF THE REPUBLIC OF MOLDOVA
Authors: CUIBAN Elena , CODREANU Igor , Tanase Adrian , TIMBALARI Tatiana , Iacob Sergiu , Gaibu Sergiu 
Published: June 2020

Abstract

Background and Aims
During the last decade, the development of kidney transplantation in the Republic of Moldova took a new course due to the adoption of the new transplantation law, and was strongly marked by the first transplant from a brain death donor. The implementation of a transparent organ allocation policy, the development of donation after brain death and the upgrade of the transplant infrastructure, based on European good practices, are the strengths of the new program.

Method
Since 2014, all the kidney grafts from deceased donors have been allocated based on the electronic allocation system (Renal Score), which includes the following variables: compatibility in ABO and HLA systems, dialysis vintage, time on waiting list, renal graft accessibility score, age difference between recipient and donor. All the living donors were evaluated based on a National Protocol. This is a retrospective analysis of the kidney transplant program during a period of five years, focused on recipient and donor demographics, donor-recipient matching, medical outcomes.

Results
During 2014-2018, there were performed 75 kidney transplantations: 23 (30,7%) from living donors and 52 (69,3 %) from brain-death donors. Among the kidney transplant recipients, there were 24 women (32,4%) and 50 men (67.6%). From 23 living kidney donors there were 10 (43,5%) males and 13 (56,5%) females, 21 (91,3%) were related donors and 2 (8,7%) emotionally related. The mean age of living donors was 50,45, ranging from 23 to 67, with 6 donors (20,1%) older than 60 years old.
During this period, from 110 evaluated potential brain death donors 48 (43,6%) became effective brain-death donors and kidneys were procured in 36 (75%) cases (from 15 men (41,7%) and 21 women (58,3%)). The mean recipients age was 41,13, ranging from 23 to 67, while the mean donor age was 54,72, ranging from 19 to 72 years old. 18 donors (50%) were older than 60, the mean age of male donors were 49,4 and 59,14 for female donors. The mean donor-recipient age difference was 17,09 years (min- 0, max- 40). The mean cold ischemia time was 17,31 hours, with a minimum of 6,33 hours and a maximum of 25,8 hours. The majority of donors were blood type 0- 14 (38.8%) and A-13 (36,1%) and only 6 donors (16.6%) blood type B and 3 (8.3%) type AB. Regarding the outcomes, we noticed a rate of delayed graft function in 43,6% cases, 2,6% of slow graft function and 53,9% recipients with immediate graft function

Conclusion
Despite social and economic challenges in our country, the joint efforts of the kidney transplant team, the Transplant Agency and the government support ensure a growing kidney transplant program. The strengths of our program are the good legal framework and the respect for the main ethical and medical principals: transparency and traceability, ensured by the informational platform, equity and utility ensured by the use of the automated allocation system, accessibility ensured by the fool coverage of transplant related services by the public health insurance. We still face many challenges, as the high rate of marginal donors compared to younger recipients and donor-recipient age disparities, a long cold ischemia time and a sub-optimal organ discard rate, which is mainly due to the shortage of transplant professionals, the direct effect of the migration of health care personnel. Our next goal is to identify and to improve the factors impacting on kidney graft outcomes in order to achieve better results.