The discard of deceased donor kidneys in the <scp>UK</scp>

Callaghan, Christopher; Harper, S.; Saeb‐Parsy, Kourosh; Hudson, Alex; Gibbs, Paul; Watson, Chris; Praseedom, Raaj K.; Butler, Andrew; Pettigrew, Gavin J.; Bradley, J. Andrew

doi:10.1111/ctr.12319

Cited by 66 publications

(89 citation statements)

References 26 publications

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“…Fifth, it is important to note that this study examined discard rates in the United States exclusively. Given the differences in discard rates that exist between countries (Supplemental Table 1) (18,19), variation in use and nonuse of ECD/DCD kidneys by country is also likely to occur.…”

Section: Discussionmentioning

confidence: 99%

Epidemiology of Kidney Discard from Expanded Criteria Donors Undergoing Donation after Circulatory Death

Singh

Kim²

2016

Clinical Journal of the American Society of Nephrology

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Background and objectives The broader use of combined expanded criteria donor and donation after circulatory death (ECD/DCD) kidneys may help expand the deceased donor pool. The purpose of our study was to evaluate discard rates of kidneys from ECD/DCD donors and factors associated with discard.Design, setting, participants, & measurements ECD/DCD donors and kidneys were evaluated from January 1, 2000 to March 31, 2011 using data from the Scientific Registry of Transplant Recipients. The kidney donor risk index was calculated for all ECD/DCD kidneys. Multivariable logistic regression models were used to determine risk factors for discarding both donor kidneys. The Kaplan-Meier product limit method and the log-rank statistic were used to assess the cumulative probability of graft failure for transplants from ECD/DCD donors where the mate kidney was discarded versus both kidneys were used.Results There were 896 ECD/DCD donors comprising 1792 kidneys. Both kidneys were discarded in 44.5% of donors, whereas 51.0% of all available kidneys were discarded. The kidney donor risk index scores were higher among donors of discarded versus transplanted kidneys (median, 1.82; interquartile range, 1.60, 2.07 versus median, 1.67; interquartile range, 1.49, 1.87, respectively; P,0.001); however, the distributions showed considerable overlap. The adjusted odds ratios for discard were higher among donors who were older, diabetic, AB blood type, and hepatitis C positive. The cumulative probabilities of total graft failure at 1, 3, and 5 years were 17.3%, 36.5%, and 55.4% versus 13.8%, 24.7%, and 40.5% among kidneys from donors where only one versus both kidneys were transplanted, respectively (log rank P=0.04).Conclusions Our study shows a significantly higher discard rate for ECD/DCD kidneys versus prior reports. Some discarded ECD/DCD kidneys may be acceptable for transplantation. Additional studies are needed to evaluate the factors that influence decision making around the use of ECD/DCD kidneys.

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Section: Discussionmentioning

confidence: 99%

Epidemiology of Kidney Discard from Expanded Criteria Donors Undergoing Donation after Circulatory Death

Singh

Kim²

2016

Clinical Journal of the American Society of Nephrology

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“…The most common reason is inadequate perfusion during in situ flushing with preservation fluid following procurement 2.…”

Section: Introductionmentioning

confidence: 99%

Successful Transplantation of Human Kidneys Deemed Untransplantable but Resuscitated by Ex Vivo Normothermic Machine Perfusion

Hosgood

Saeb‐Parsy

Hamed

et al. 2016

American Journal of Transplantation

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We report the successful transplantation of a pair of human kidneys that were declined for transplantation due to inadequate in situ perfusion but subsequently transplanted after perfusion and assessment using ex vivo normothermic perfusion (EVNP). The kidneys were from a 35‐year‐old man, a donation after circulatory death donor. Both kidneys were declined by all UK transplant centers. On arrival, the kidneys had significant areas of incomplete clearance of blood from the microcirculation that did not clear after a further attempt to flush them. Kidneys underwent 60 min of EVNP with an oxygenated packed red blood cell–based solution warmed to 35.2°C. During EVNP, the patchy areas cleared in both kidneys. The mean renal blood flow and total urine output were 68.0 mL/min/100 g and 560 mL in the left kidney and 59.9 mL/min/100 g, 430 mL in the right, respectively. Based on the EVNP perfusion parameters, both kidneys were deemed suitable for transplantation. They were transplanted without any complications, and both recipients had initial graft function. The serum creatinine levels at 3 months were 1.2 mg/dl in the recipient of the left kidney and 1.62 mg/dl in the recipient of the right kidney. EVNP technology can be used to assess and rescue kidneys previously deemed unsuitable for transplantation.

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“…A szer-ző megállapítja, hogy 20 visszautasított vese közül utó-lag négyet biztosan, további kilencet feltehetően beültet-hetőnek tartottak. A közlemény alapján megkérdőjelezték és át is alakították a brit felajánlási rendszert az úgyneve-zett hard-to-place (nehezen allokálható) donorvesékre nézve: egyszerre 3 centrumnak is megtörténik párhuza-mosan a felajánlás [17]. A fentiek alátámasztják a debreceni gyakorlatot.…”

Section: áBraunclassified

Eredményeink a teljes jogú Eurotransplant-tagság óta. A Debreceni Vesetranszplantációs Központ tapasztalatai

et al. 2016

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Bevezetés: A Debreceni Egyetemen 1991-ben végezték el az első veseátültetést. Hazánk 2013-ban csatlakozott az Eurotransplanthoz. Célkitűzés: A szerzők elemezték a tapasztalatokat. Módszer: 2008. január 1. és 2013. augusztus 31. között (A csoport = 163) és 2013. szeptember 1. és 2015. október 22. között végzett cadavervese-átültetések (B csoport = 90) adatait elemezték. Eredmények: Az élődonorok aránya 3,5%-ról 9,1%-ra nőtt. 2013 óta a recipiensek 25%-a 60 évesnél idősebb, a >30 kg/m 2 testtömegindex aránya 31%-ra, a diabetesesek aránya kétszeresére emelkedett. Az ureteroneocystostomia mellett bevezetésre került a vég az oldalhoz ureteroureteralis anastomosis. Indukciós kezelés mellett az akut rejectiós epizód jelentősen csökkent (34%-ról 8%-ra). A technikai szövődmények aránya nem változott. A bakteriális fertőzések aránya csökkent (41%-ról 33%-ra). Az 1, 3 és 5 éves veseallograft-túlélések 86,6%, 85% és 82,7%, valamint 88%, 84% és 84% voltak a két csoportban. Következtetések: Az extended criteria donor arány emelkedett. 2013 óta lehetségessé vált az akut humoralis rejectio kezelése. Az esetszám-növekedés mellett az eredmények jók. Orv. Hetil., 2016, 157(24), 925-937. Results: The proportion of living transplants rose from 3.5% to 9.1 %. During period B over 25% of utilized donors were over 60 years of age. Recipients with body mass index above 30 kg/m 2 increased from 12% to 31%. Prevalence of diabetes among recipients rose twofold. Uretero-neocystostomy was used during period A (99%) while in period B end to side uretero-ureteral anastomosis has also gained popularity (68%). In 2013 the authors introduced routine use of induction treatment. Acute rejection rate decreased from 34% to 8%. The rate of surgical complications did not change. Acute bacterial infections decreased from 41% to 33%. Cumulative renal allograft 1, 3 and 5 year survival rates were 86.6%, 85% and 82.7% in group A vs. projected rates 88%, 84% and 84% in group B, respectively. Conclusions: Despite the growing proportion of expanded criteria donors, the authors were able to maintain a low incidence of delayed graft function and a favorable graft survival. Since 2013 the authors introduced treatments for acute humoral rejection according to international standards.

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The discard of deceased donor kidneys in the UK

Cited by 66 publications

References 26 publications

Epidemiology of Kidney Discard from Expanded Criteria Donors Undergoing Donation after Circulatory Death

Epidemiology of Kidney Discard from Expanded Criteria Donors Undergoing Donation after Circulatory Death

Successful Transplantation of Human Kidneys Deemed Untransplantable but Resuscitated by Ex Vivo Normothermic Machine Perfusion

Eredményeink a teljes jogú Eurotransplant-tagság óta. A Debreceni Vesetranszplantációs Központ tapasztalatai

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