Donation after brain death followed by circulatory death, a novel donation pattern, confers comparable renal allograft outcomes with donation after brain death

Abstract

BackgroundOrgan donation after brain death (DBD) is the standard strategy for organ transplantation; however, the concept of brain death is not universally accepted due to cultural beliefs and barriers amongst billions of people worldwide. Hence, a novel donation pattern has been established in China which outlines the concept of donation after brain death followed by circulatory death (DBCD). Differently from any current donation classification, this new concept is formulated based on combination of recognizing brain death and circulatory death. Should approval be gained for this definition and approach, DBCD will pave a novel donation option for billions of people who cannot accept DBD due to their cultural beliefs.MethodsA multi-center, cohort study was conducted from February 2012 to December 2015. 523 kidney transplant recipients from four kidney transplant institutions were enrolled into the study, of which, 383 received kidneys from DBCD, and 140 from DBD. Graft and recipient survivals following transplantation were retrospectively analyzed. Postoperative complications including delayed graft function,, and acute rejection, were also analyzed for both groups.ResultsDBCD could achieve comparable graft and recipient survivals in comparison with DBD (Log-rank P = 0.32 and 0.86,respectively). One-year graft and recipient survivals were equal between DBCD and DBD groups (97.4% versus 97.9%, P = 0.10;98.4% versus 98.6%, P = 1.0, respectively). Furthermore, DBCD did not increase incidences of postoperative complications compared with DBD, including delayed graft function (19.3% versus 22.1%, P = 0.46) and acute rejection (9.1% versus 8.6%, P = 1.0). Additionally, antithymocyte globulin as induction therapy and shorter warm ischemia time decreased incidence of delayed graft function in DBCD group (16.8% on antithymocyte globulin versus 27.2% on basiliximab, P = 0.03; 16.7% on ≤18 min versus 26.7% on > 18 min group, P = 0.03).ConclusionsKidney donation through DBCD achieves equally successful outcomes as DBD, and could provide a feasible path to graft availability for billions of people who face barriers to organ donation from DBD.

Post-Kidney Transplantation Results After Circulatory or Brain Death Without Pre-Mortem Heparin Administration

“…In our study, the difference in time to graft failure was not statistically significant between the groups. This is in accordance with studies reporting 1-year graft function rates of 87.0 to 98.3% for the DBD group and 85.0 to 100% for the DCD group [ 2 , 3 , 19 , 21 ]. In the aforementioned meta-analysis, a 13% higher risk of graft loss was reported for the DCD group compared to DBD (RR 1.13; 95% CI 1.08; 1.19).…”

“…The overall mortality in kidney transplantation studies is 92.8–98.3% in DBD and 94.9–100% in DCD grafts [ 2 , 3 , 19 , 21 ], which agrees well with our results.…”

“…Primary non-function (PNF) is generally a rare event [ 19 , 20 ], which was also confirmed in our study. In our opinion, a technical error during transplantation is probably the most likely cause of this event; prolonged warm graft ischemia or perivascular capillary edema may also play a role [ 2 ]. Large European studies report that the frequency of PNF in patients after DCD transplantation is as high as 5.0%, which is much higher than the 0.7–0.9% reported for DBD grafts [ 21 ].…”

“…Finding a suitable kidney donor is therefore often a lengthy process that significantly prolongs the time to transplantation for potential recipients, despite a good national transplant policy and effective coordination of the transplantation program. Although in the past only donors after brain death (DBD) were considered for inclusion in the transplantation program, efforts to expand the donor pool have also led to the inclusion of donors with circulatory failure (donors after circulatory death, DCD) [ 1 ] or those with a combination of both conditions (donor after brain death followed by circulatory death, DBCD) [ 2 ]. Although the latter is rarely used in the Czech Republic, both DBD and DCD kidney transplants are routinely used in national transplant centers.…”

Long-term outcomes of kidney transplantation from expanded criteria donors with Chinese novel donation policy: donation after citizens’ death

“…Acute rejection (AR) was suggested clinically by an unexplained rise in serum creatinine concentration of > 0.3 mg/dL or a 25% increase from baseline [ 8 ]. The diagnosis of AR was confirmed by percutaneous kidney biopsy, and kidney pathology was classified using Banff 07 classification and its subsequent updates [ 9 ].…”