Implementation of donation after circulatory death kidney transplantation can safely enlarge the donor pool: A systematic review and meta-analysis

Rijkse, Elsaline; Ceuppens, Sebastiaan; Qi, Hongchao; IJzermans, Jan N.M.; Hesselink, Dennis A.; Minnee, Robert C.

doi:10.1016/j.ijsu.2021.106021

Cited by 39 publications

(32 citation statements)

References 74 publications

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“…DCD donation has seen a rapid expansion and in many countries provides a significant contribution to the donor pool (28). Whilst very good DCD renal organ utilisation and transplant outcomes have been achieved, the situation is different for other solid organs where lower utilisation rates, increased complication rates, and inferior long-term survival rates have been reported (29). Despite several refinements in the donation process and more stringent selection criteria, it is really the advent of novel in situ and ex situ perfusion technologies that holds the greatest promise for a leap improvement in utilisation and outcomes.…”

Section: Discussionmentioning

confidence: 99%

From Haphazard to a Sustainable Normothermic Regional Perfusion Service: A Blueprint for the Introduction of Novel Perfusion Technologies

Hunt¹,

Johnston²,

Coutts³

et al. 2022

Transpl Int

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Normothermic Regional Perfusion (NRP) has shown encouraging clinical results. However, translation from an experimental to routine procedure poses several challenges. Herein we describe a model that led to the implementation of NRP into standard clinical practice in our centre following an iterative process of refinement incorporating training, staffing and operative techniques. Using this approach we achieved a four-fold increase in trained surgical staff and a 6-fold increase in competent senior organ preservation practitioners in 12 months, covering 93% of the retrieval calls. We now routinely provide NRP throughout the UK and attended 186 NRP retrievals from which 225 kidneys, 26 pancreases and 61 livers have been transplanted, including 5 that were initially declined by all UK transplant centres. The 61 DCD(NRP) liver transplants undertaken exhibited no primary non-function or ischaemic cholangiopathy with up to 8 years of follow-up. This approach also enabled successful implementation of ex situ normothermic liver perfusion which together with NRP contributed 37.5% of liver transplant activity in 2021. Perfusion technologies (in situ and ex situ) are now supported by a team of Advanced Perfusion and Organ Preservation Specialists. The introduction of novel perfusion technologies into routine clinical practice presents significant challenges but can be greatly facilitated by developing a specific role of Advanced Perfusion and Organ Preservation Specialist supported by a robust education, training and recruitment programme.

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Section: Discussionmentioning

confidence: 99%

From Haphazard to a Sustainable Normothermic Regional Perfusion Service: A Blueprint for the Introduction of Novel Perfusion Technologies

Hunt¹,

Johnston²,

Coutts³

et al. 2022

Transpl Int

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“…Acute rejection of the graft is also relatively rare, with reported frequencies of 0.0–8.5% for DBD and 5.5–8.0% for DCD in the case of kidney transplantation [ 3 – 5 ]. Furthermore, a recent (2021) meta-analysis by Rijkse et al concluded that the risk of PNF (RR 1.43; 95% CI 1.26; 1.62) and DGF (RR 2.02; 95% CI 1.88; 2.16) is higher in patients in the DCD group [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2022

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Background Kidney donation after circulatory death (DCD) follows confirmation of death using cardiorespiratory criteria, while donation after brain death (DBD) uses neurological criteria. DBD and DCD donors are the main sources of grafts for transplantation. This retrospective cohort study from a single center in the Czech Republic aimed to compare 5-year post-transplantation outcomes after DCD and DBD transplantation without pre-mortem heparin administration. Material/Methods A total of 227 recipients with matched donors enrolled in the transplantation program at our institution between 2015 and 2019 were analyzed. Following the application of the inclusion criteria, 99 recipients and 94 matched donors were finally included in the study. Results The duration of cold ischemia (median 961 vs 1100 min, P =0.028) and the perfusion with the preservation solution (median 11 vs 22 min, P <0.001) was statistically significantly shorter in DBD than in DCD grafts. The 1-year survival rates were 97.5% (95% CI 94.1–100.0%) and 90.0% (95% CI: 77.8–100.0%) for DBD and DCD recipients, respectively. The 3-year survival rates were 91.9 (95% CI: 86.0–98.4) and 90.0 (95% CI: 77.8–100.0) for the DBD and DCD groups, respectively. The overall difference in survival between the 2 groups of patients was not statistically significant ( P =0.750) nor was disease-free survival ( P =0.370). Conclusions This retrospective study from a single center showed similar 5-year results after kidney transplantation for DCD and DBD donors without pre-mortem heparin administration, including the time to graft failure and patient survival.

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“…This concept has proven to work in the case of liver transplantation, as the use of combined HMP and NMP to assess declined donor livers resulted in a 20% increase in the number of deceased donor liver transplantations [ 33 ]. Lastly, the high number of DCD kidneys being transplanted is accompanied by higher numbers of PNF [ 34 ]. The possibility of viability assessment pre-transplant may help decrease the numbers of PNF kidneys being transplanted.…”

Section: Discussionmentioning

confidence: 99%

Additional Normothermic Machine Perfusion Versus Hypothermic Machine Perfusion in Suboptimal Donor Kidney Transplantation: Protocol of a Randomized, Controlled, Open-Label Trial

Rijkse

Bouari

Kimenai

et al. 2021

International Journal of Surgery Protocols

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Introduction: Ageing of the general population has led to an increase in the use of suboptimal kidneys from expanded criteria donation after brain death (ECD-DBD) and donation after circulatory death (DCD) donors. However, these kidneys have inferior graft outcomes and lower rates of immediate function. Normothermic machine perfusion (NMP) may improve outcomes of these suboptimal donor kidneys. Previous nonrandomized studies have shown the safety of this technique and suggested its efficacy in improving the proportion of immediate functioning kidneys compared to static cold storage (SCS). However, its additional value to hypothermic machine perfusion (HMP), which has already been proved superior to SCS, has not yet been established. Methods and analysis:This single-center, open-label, randomized controlled trial aims to assess immediate kidney function after 120 minutes additional, end-ischemic NMP compared to HMP alone. Immediate kidney function is defined as no dialysis treatment in the first week after transplant. Eighty recipients on dialysis at the time of transplant who receive an ECD-DBD or DCD kidney graft are eligible for inclusion. In the NMP group, the donor kidney is taken of HMP upon arrival in the recipient hospital and thereafter put on NMP for 120 minutes at 37 degrees Celsius followed by transplantation. In the control group, donor kidneys stay on HMP until transplantation. The primary outcome is immediate kidney function. Ethics and dissemination:The protocol has been approved by the Medical Ethical Committee of Erasmus Medical Center (2020-0366). Results of this study will be submitted to peer-reviewed journals.Registration: registered in clinicaltrials.gov (NCT04882254). Highlights:• This is the first RCT to compare additional NMP to HMP alone.• Extensive sampling will offer in-depth analysis of kidney physiology during NMP.• This RCT may help identify biomarkers to predict clinical outcomes during NMP.• Biomarkers can help develop NMP as assessment tool for declined kidneys.

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Implementation of donation after circulatory death kidney transplantation can safely enlarge the donor pool: A systematic review and meta-analysis

Cited by 39 publications

References 74 publications

From Haphazard to a Sustainable Normothermic Regional Perfusion Service: A Blueprint for the Introduction of Novel Perfusion Technologies

From Haphazard to a Sustainable Normothermic Regional Perfusion Service: A Blueprint for the Introduction of Novel Perfusion Technologies

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

Additional Normothermic Machine Perfusion Versus Hypothermic Machine Perfusion in Suboptimal Donor Kidney Transplantation: Protocol of a Randomized, Controlled, Open-Label Trial

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