Analysis of risk factors for donation after circulatory death kidney transplantation in Japan

Abstract

Background In Japan, donations after circulatory death kidney transplantation are widely performed due to legislation delays. The number of donations after brain death kidney transplantations is increasing, but the target remains unmet. We reviewed the outcomes of donation after circulatory death in Japan. Methods We analyzed 2923 deceased kidney transplantations (2239: donation after circulatory death (DCD), 684: donation after brain death (DBD)) performed in Japan from 2000 to 2019. The outcomes of the DCD and DBD groups were compared. We examined the risk factors for graft loss in the DCD group. ResultsThe 5-year patient survival and death-censored graft survival rates of the DCD group, obtained by propensity score matching, were 93.6% and 95.2%, respectively, which were equivalent to 94.2% and 93.8%, respectively, obtained in the DBD group. Older donors (≥ 50 years) and prolonged cold ischemia time (≥ 12 h) were risk factors for graft loss; in the presence of these, graft survival was lower in the DCD group. Conclusions Older donors and prolonged cold ischemia time reduced graft survival in the DCD group. Proper evaluation of donors and careful preparation for transplant surgery are, therefore, essential to ensure good transplant outcomes. Keywords Kidney transplantation • Donation after circulatory death • Cold ischemia time Abbreviations DCD Donation after circulatory death DBD Donation after brain death CIT Cold ischemic time WIT Warm ischemia time CVD Cerebrovascular disorder

Comprehensive management analysis of 75 deceased donors maintained in ICU: a single center experience

“…Studies have shown that donor age affects the e ciency of donation. Donors older than 50 have lower organ utilization and lower survival rate of transplanted organs [4,5]. This may be because elderly donors may be accompanied by cardiovascular and cerebrovascular diseases.…”

“…In 2021, 144,302 organ transplants were completed worldwide (11.3% increase over 2020). In 2021, China has completed 19,386 organ transplants, ranking as one of the world's four major organ transplant countries with the United States (42,217), Brazil (7,088) and Spain (4,781). Organ transplants in these four countries accounts for more than 50% of the world [1].…”

The History of Clinical Islet Transplantation in Japan

“…Until the law on organ transplantation from brain-dead donors was enacted in 1997, there was no legislation for organ donation from brain-dead donors in Japan, so less than 200 cases of kidney transplantation from less than 100 donors after cardiac arrest were performed [ 21 , 22 ]. In this era, the Tokyo Women’s Medical University Group performed 11 cases of pancreas transplantation from donors after cardiac arrest [ 23 , 24 ].…”

Porcine anti-human lymphocyte immunoglobulin depletes the lymphocyte population to promote successful kidney transplantation

“…The development of immunosuppressant therapies has greatly improved organ and recipient survival (3)(4)(5). However, acute rejection (AR) and delayed graft function (DGF) remain treatment obstacles that impair KTx outcomes, especially in the current era of donation after circulatory death (DCD) (6,7). Induction therapy, based on the conventional triple maintenance immunosuppressive therapy, can reduce the incidence of postoperative AR and DGF, allow for reduced immunosuppressant doses, and prolong transplanted kidney and recipient survival (8)(9)(10).…”