Expanding the Donor Kidney Pool: Utility of Renal Allografts Procured in a Setting of Uncontrolled Cardiac Death

Singh, Gaurav; Matsuoka, Lea; Mateo, Rod; Cho, Y W; Genyk, Yuri; Sher, Linda; Cicciarelli, J; Aswad, S.; Jabbour, Nicolas; Selby, Rick

doi:10.1111/j.1600-6143.2006.01386.x

Cited by 95 publications

(76 citation statements)

References 21 publications

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“…Over the last decade as experience with DCD transplantation has grown, many single center studies have reported equivalent long-term graft survival and equivalent rates of primary non-function (PNF) between recipients of DCD kidneys and SCD kidneys (10,(12)(13)(14)(15)(16)(17)(18). Further, several retrospective analyses of the United Network for Organ Sharing (UNOS) database, including reports by Rudich et al and more recently Doshi and Hunsicker, have compared short and long term outcomes among recipients of DBD and DCD kidneys, and have demonstrated that DCD kidneys have equivalent patient and graft survival rates at 5 years compared to DBD (SCD and ECD) kidneys (19,20).…”

Section: Introductionmentioning

confidence: 99%

Outcomes of Kidneys from Donors After Cardiac Death: Implications for Allocation and Preservation

Locke

Segev

Warren

et al. 2007

American Journal of Transplantation

223

198

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Although donation after cardiac death (DCD) kidneys have a high incidence of delayed graft function (DGF) and have been considered marginal, no tool for stratifying risk of graft loss nor a specific policy governing their allocation exist. We compared outcomes of 2562 DCD, 62 800 standard criteria donor (SCD) and 12 812 expanded criteria donor (ECD) transplants reported between 1993 and 2005, and evaluated factors associated with risk of graft loss and DGF in DCD kidneys. Donor age was the only criterion used in the definition of ECD kidneys that independently predicted graft loss among DCD kidneys. Kidneys from DCD donors <50 had similar long-term graft survival to those from SCD (RR 1.1, p = NS). While DGF was higher among DCD compared to SCD and ECD, limiting cold ischemia (CIT) to <12 h decreased the rate of DGF 15% among DCD <50 kidneys. These findings suggest that DCD <50 kidneys function like SCD kidneys and should not be viewed as marginal or ECD, and further, limiting CIT <12 h markedly reduces DGF.

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Section: Introductionmentioning

confidence: 99%

Outcomes of Kidneys from Donors After Cardiac Death: Implications for Allocation and Preservation

Locke

Segev

Warren

et al. 2007

American Journal of Transplantation

223

198

View full text Add to dashboard Cite

show abstract

“…It has been estimated, however, that effective use of these potential donors would add greatly to the number of organ donors [10]. This contrasts with the situation in renal transplantation in which organs from uncontrolled DCD have been used by some centres with outcomes that compare well with those from controlled DCD donors [11]. Following renal transplantation, a period of 'delayed graft function' is acceptable because it is possible to support the patient with dialysis whilst the transplanted organ recovers from the ischaemic injury; an equivalent delay in initial function of a transplanted liver is fatal without urgent re-transplantation.…”

Section: Donation After Circulatory Death (Dcd)mentioning

confidence: 58%

A multicentre randomised controlled trial to compare the efficacy of ex-vivo normothermic machine perfusion with static cold storage in human liver transplantation

Nasralla¹,

Akhtar²,

Bradley³

et al. 2018

Protocol Exchange

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“…Fifty-five percent of patients needed at least one session of hemodialysis (DGF) postoperatively [60] . Use of DCD whether controlled or uncontrolled is associated with high PNF and DGF but the long term outcome is satisfactory (Table 2) [7,19,61] . However, some reports showed no significant difference between DCD and DBD.…”

Section: Dgf and Primary Non Functionmentioning

confidence: 99%

“…Gagandeep et al [7] 2006 Sanchez-Fructuoso et al [55] 2000 (1989)(1990)(1991)(1992)(1993)(1994)(1995)(1996)(1997)(1998) Sanchez-Fructuoso et al [65] 2004 (1990-1998) Cooper et al [70] 2004 ( Akoh JA. Kidney donation after cardiac death increased, DBD decreased by 20% in the three countries with a predominant controlled DCD activity, while DBD had increased in the majority of European countries.…”

Section: Series Type Number Patient Survival (%) Graft Survival (%) Dmentioning

confidence: 99%

“…DCD represents a growing source of kidneys for transplantation in the United States, although not to the same extent as in Europe [6] . Review of United Network for Organ Sharing data showed a yearly trend of increasing DCD (controlled more than uncontrolled) donors between 1995 and 2004 [7] . Similarly, the number of organs recovered from DCD grew from 64 in 1995 to 391 in 2004 [8] .…”

Section: Introductionmentioning

confidence: 99%

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Kidney donation after cardiac death

Akoh¹

2012

WJN

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There is continuing disparity between demand for and supply of kidneys for transplantation. This review describes the current state of kidney donation after cardiac death (DCD) and provides recommendations for a way forward. The conversion rate for potential DCD donors varies from 40%-80%. Compared to controlled DCD, uncontrolled DCD is more labour intensive, has a lower conversion rate and a higher discard rate. The super-rapid laparotomy technique involving direct aortic cannulation is preferred over in situ perfusion in controlled DCD donation and is associated with lower kidney discard rates, shorter warm ischaemia times and higher graft survival rates. DCD kidneys showed a 5.73-fold increase in the incidence of delayed graft function (DGF) and a higher primary non function rate compared to donation after brain death kidneys, but the long term graft function is equivalent between the two. The cold ischaemia time is a controllable factor that significantly influences the outcome of allografts, for example, limiting it to < 12 h markedly reduces DGF. DCD kidneys from donors < 50 function like standard criteria kidneys and should be viewed as such. As the majority of DCD kidneys are from controlled donation, incorporation of uncontrolled donation will expand the donor pool. Efforts to maximise the supply of kidneys from DCD include: implementing organ recovery from emergency department setting; improving family consent rate; utilising technological developments to optimise organs either prior to recovery from donors or during storage; improving organ allocation to ensure best utility; and improving viability testing to reduce primary non function.

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Expanding the Donor Kidney Pool: Utility of Renal Allografts Procured in a Setting of Uncontrolled Cardiac Death

Cited by 95 publications

References 21 publications

Outcomes of Kidneys from Donors After Cardiac Death: Implications for Allocation and Preservation

Outcomes of Kidneys from Donors After Cardiac Death: Implications for Allocation and Preservation

A multicentre randomised controlled trial to compare the efficacy of ex-vivo normothermic machine perfusion with static cold storage in human liver transplantation

Kidney donation after cardiac death

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