Five-year experience with donation after cardiac death kidney transplantation in a Canadian transplant program: Factors affecting outcomes

Abstract

Background: Donation after cardiac death (DCD) has led to an increase of up to 40% in the number of kidney transplants in some programs. Unfortunately, the increase in warm ischemic time results in higher rates of delayed graft function (DGF). The purpose of our study was to examine our initial 5-year experience with DCD kidney transplantation and to determine the factors involved in early postoperative function and function at 1 year. Results: DGF was seen in 65% of transplanted kidneys. Mean creatinine clearance (CrCl) at 1 year was 66.7 mL/min. Low pretransplant recipient daily urine output was the most statistically significant predictor of DGF in multivariate analysis (p < 0.001). In comparisons between our early and more recent results, improvements were noted in time from asystole to flush (16.0 vs. 12.0 minutes, p = 0.003), while cold ischemic time increased (464 vs. 725 minutes, p = 0.006). Experience contributed to a significant reduction in hospital length of stay (16 vs. 13 days, p = 0.035) and improved early renal function (CrCl at 3 days 7.8 vs. 11.9 mL/ min, p = 0.027). The use of machine cold perfusion and higher recipient preoperative daily urine output predicted improved early renal function, while increasing donor age predicted poorer function at 1 year. Discussion: Despite early DGF, our results justify the continued transplantation of kidneys from DCD donors.

Does prolonged cold ischemia affect outcomes in donation after cardiac death donor kidney transplants?

“…Comparable medium to long-term outcomes between DCD and DBD donor kidneys at lower CITs are well established. [28][29][30] Studies assessing DCD donor KT have previously shown increasing rates of DGF compared to DBD donor kidneys 31 and higher rates of DGF with increasing CIT. 29,32 Conflicting evidence regarding the significance of DGF in DCD donor KTs outcomes exists with some studies indicating that the presence of DGF does not adversely influence outcomes, 28,33 while others have found that DGF does indeed result in decreased GS.…”

Mitochondria and Antibiotics: For Good or for Evil?

“…Donation after neurological determination of death (DCDD) had been the only source of deceased donor organs for most of transplant programs since the late 1960s [220]. Unfortunately, kidney donors are associated with a higher rate of delayed graft function, and reduced graft survival [221].…”

Pursuing Expanded Criteria Donors as Candidates for Kidney Donation after Circulatory Death

“…2014;24:206-210) functions or circulatory determination of death. 6 However, with brain-dead donors practically eliminating warm ischemic time, resulting in higher quality organs and appearing to provide an adequate supply of organs, DCD organ recoveries decreased substantially across the United States. 6 Even though the Collaborative was successful in increasing and sustaining overall rates of organ donation from deceased donors, including an increase in DCD donors, as the number of candidates listed for transplant continues to increase, the number of available donors has remained relatively static.…”

“…6 However, with brain-dead donors practically eliminating warm ischemic time, resulting in higher quality organs and appearing to provide an adequate supply of organs, DCD organ recoveries decreased substantially across the United States. 6 Even though the Collaborative was successful in increasing and sustaining overall rates of organ donation from deceased donors, including an increase in DCD donors, as the number of candidates listed for transplant continues to increase, the number of available donors has remained relatively static. In the past 6 years (2007-2012), the total number of organ donors was 85 900, of which 79 836 were kidney donors (43 769 deceased donors and 36 067 living donors) for a mean of 14 316 total organ donors, of which 13 306 were kidney donors (7295 deceased donors and 6011 living donors), per year.…”