DCD kidney transplantation: results and measures to improve outcome

Hoogland, E.R. Pieter; Snoeijs, Maarten G.; Heurn, LW van

doi:10.1097/mot.0b013e32833734b1

Cited by 39 publications

(20 citation statements)

References 35 publications

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“…Regarding the post-transplant results, we have not found a statistically significant difference regarding the incidence of PNF between kidney recipients transplanted from controlled versus uncontrolled DCD, similar to what has been described elsewhere [26][27][28][29]. However, the incidence of DGF is significantly higher in recipients transplanted from uncontrolled DCD and similar to that reported in the literature for both types of DCD [26][27][28][29][30][31][32][33]. In spite of a higher incidence of DGF, 1 year graft survival is similar in both groups and even higher for recipients of uncontrolled DCD kidneys.…”

Section: Discussionsupporting

confidence: 88%

Current situation of donation after circulatory death in European countries

Domínguez‐Gil

Haase‐Kromwijk²,

Leiden³

et al. 2011

Transplant International

254

137

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The aim of the present study was to describe the current situation of donation after circulatory death (DCD) in the Council of Europe, through a dedicated survey. Of 27 participating countries, only 10 confirmed any DCD activity, the highest one being described in Belgium, the Netherlands and the United Kingdom (mainly controlled) and France and Spain (mainly uncontrolled). During 2000-2009, as DCD increased, donation after brain death (DBD) decreased about 20% in the three countries with a predominant controlled DCD activity, while DBD had increased in the majority of European countries. The number of organs recovered and transplanted per DCD increased along time, although it remained substantially lower compared with DBD. During 2000-2008, 5004 organs were transplanted from DCD (4261 kidneys, 505 livers, 157 lungs and 81 pancreas). Short-term outcomes of 2343 kidney recipients from controlled versus 649 from uncontrolled DCD were analyzed: primary non function occurred in 5% vs. 6.4% (P = NS) and delayed graft function in 50.2% vs. 75.7% (P < 0.001). In spite of this, 1 year graft survival was 85.9% vs. 88.9% (P = 0.04), respectively. DCD is increasingly accepted in Europe but still limited to a few countries. Controlled DCD might negatively impact DBD activity. The degree of utilization of DCD is lower compared with DBD. Short-term results of DCD are promising with differences between kidney recipients transplanted from controlled versus uncontrolled DCD, an observation to be further analyzed

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Section: Discussionsupporting

confidence: 88%

Current situation of donation after circulatory death in European countries

Domínguez‐Gil

Haase‐Kromwijk²,

Leiden³

et al. 2011

Transplant International

254

137

View full text Add to dashboard Cite

show abstract

“…After an obligatory 5-minute no-touch period, the preferred Dutch preservation technique for uDCD is in-situ perfusion, the insertion of a double-balloon triple-lumen catheter via the femoral artery followed by a cold flush-out with histidine-tryptophan-ketoglutarate solution (Custodiol), described elsewhere. 17,18 After starting the in-situ perfusion, donor nephrectomy is initiated within 2 hours. Other donor criteria for uDCD are age younger than 65 years, resuscitation of less than 90 minutes, and no systemic signs of infection or evidence of sepsis.…”

Section: Methodsmentioning

confidence: 99%

Similar 5-Year Estimated Glomerular Filtration Rate Between Kidney Transplants From Uncontrolled and Controlled Donors After Circulatory Death—A Dutch Cohort Study

Peters‐Sengers

Heide

Heemskerk³

et al. 2017

Transplantation

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Background. Organ shortage persists despite a high rate of donation after circulatory death (DCD) in the Netherlands. The median waiting time for a deceased donor kidney in 2013 was 3.5 years. Most DCD kidneys are from controlled DCD (cDCD; Maastricht category III). Experience with uncontrolled donors after cardiac death (uDCD), that is, donors with an unexpected and irreversible cardiac arrest (Maastricht categories I and II), is increasing; and its effect on transplant outcomes needs evaluation. Methods. We used the Dutch Organ Transplantation Registry to include recipients (≥18 years old) from all Dutch centers who received transplants from 2002 to 2012 with a first DCD kidney. We compared transplant outcome in uDCD (n = 97) and cDCD (n = 1441). Results. Primary nonfunction in uDCD was higher than in the cDCD (19.6% vs 9.6%, P < 0.001, respectively). Delayed graft function was also higher in uDCD than in cDCD, but not significantly (73.7% vs 63.3%, P = .074, respectively). If censored for primary nonfunction, estimated glomerular filtration rates after 1 year and 5 years were comparable between uDCD and cDCD (1 year: uDCD, 44.3 (23.4) mL/min/m 2 and cDCD, 45.8 (24.1) mL/min/m

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“…We consider this analysis with caution because of the low statistical power and the short follow-up times, but it allows us to identify modifiable factors. DGF is an intermediate end-point depending on other factors, such as the immunosuppressive regimen used, the cold ischemic time, and the ages of both the donors and recipients [8]. Measures to reduce the incidence of DGF such as decreasing cold ischemic time and delaying use of tacrolimus among others may improve outcomes in this type of kidney transplantation.…”

Section: Discussionmentioning

confidence: 99%