Kidney Donation after Cardiac Death in Korea

Kim, J.M.; Kim, S.-J.; Joh, Jae‐Won; Kwon, Choon Hyuck David; Song, Suk-Won; Shin, Min Jae; Kim, B.N.; Lee, S.-K.

doi:10.1016/j.transproceed.2011.01.185

Cited by 10 publications

(10 citation statements)

References 3 publications

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“…Pine and co-workers [68] found DCD graft function was worse than the DBD equivalent at 1-and 3-year, but noted that the medium-term recipient and graft outcomes were comparable. There were no statistically significant differences in serum creatinine levels or in the graft survival rates between groups at 12 mo [62] . Akoh et al [12] in a smaller series of 61 transplants found equivalence between DBD and DCD in kidney graft function at 12 mo.…”

Section: Dgf and Primary Non Functionmentioning

confidence: 69%

“…However, some reports showed no significant difference between DCD and DBD. In a retrospective series of 446 deceased donor kidney transplant recipients between 1995 and 2009, 24 (5.4%) patients who received DCD kidney grafts had a longer hospital stay after transplantation, but there was no statistically significant difference in DGF and PNF [62] .…”

Section: Dgf and Primary Non Functionmentioning

confidence: 96%

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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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Section: Dgf and Primary Non Functionmentioning

confidence: 69%

Section: Dgf and Primary Non Functionmentioning

confidence: 96%

Kidney donation after cardiac death

Akoh¹

2012

WJN

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“…In Korea, organ transplantation from a DCD donor is now emerging, and the clinical outcome of a DCD program has been recently reported in Korea (3). Outcomes after DCD kidney transplantation have been previously described to be inferior to DBD kidney transplantation (11, 12), because DCD kidneys inevitably sustain a longer period of warm ischemia than DBD.…”

Section: Discussionmentioning

confidence: 99%

Kidney Transplantation from a Donor Following Cardiac Death Supported with Extracorporeal Membrane Oxygenation

Lee

Hong

et al. 2012

J Korean Med Sci

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To expand the donor pool, organ donation after cardiac death (DCD) has emerged. However, kidneys from DCD donors have a period of long warm ischemia between cardiac arrest and the harvesting of the organs. Recently, we used extracorporeal membrane oxygenation (ECMO) to minimize ischemic injury during 'no touch' periods in a Maastricht category II DCD donor and performed two successful kidney transplantations. The kidneys were procured from a 49-yr-old male donor. The warm ischemia time was 31 min, and the time of maintained circulation using ECMO was 7 hr 55 min. The cold ischemia time was 9 hr 15 min. The kidneys were transplanted into two recipients and functioned immediately after reperfusion. The grafts showed excellent function at one and three months post-transplantation; serum creatinine (SCr) levels were 1.0 mg/dL and 0.8 mg/dL and the estimated glomerular filtration rates (eGFR) were 63 mL/min/1.73 m2 and 78 mL/min/1.73 m2 in the first recipient, and SCr levels were 1.1 mg/dL and 1.0 mg/dL and eGFR were 56 mL/min/1.73 m2 and 64 mL/min/1.73 m2 in the second recipient. In conclusion, it is suggested that kidney transplantation from a category II DCD donor assisted by ECMO is a reasonable modality for expanding donor pool.

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“…Through a systematic review , we identified four scenarios explored by the discrete choice experiment method. The questionnaire was validated by a pilot study.…”

Section: Methodsmentioning

confidence: 99%

Patients’ preferences in transplantation from marginal donors: results of a discrete choice experiment

et al. 2017

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To increase the donor pool, the strategy of transplantation from "marginal" donors was developed though patients' preferences about these donors were insufficiently known. The preferences of patients registered on the waiting list or already transplanted in eight transplant teams covering four main organs (i.e., kidney, liver, heart, and lung) were evaluated using the discrete choice experiment method. In each left during 2 days, patients were interviewed on four scenarios. Of 178 eligible patients, 167 were interviewed; 40% accepted marginal graft in their own situation and 89% at least in one of the scenarios. Imagining urgent situations or rare profiles with difficult access to transplantation, respectively, 86% and 71% accepted these grafts. Most (76%) preferred to be informed about these grafts and 43% preferred to be involved in decision. The emergency [OR = 1.24; 95% CI: (1.06-1.45)] and the hazardousness [OR = 0.88; 95% CI: (0.78-0.99)] of the transplantation were factors independently associated with marginal graft acceptance. Most patients preferred to be informed and to be involved in the decision. Marginal grafts could be more accepted by patients in critical medical situations or perceiving their situation as critical. Physicians' practices in transplantation should be reconsidered taking into account individual preferences. This study was performed in a single country and thus reflects the cultural bias and practice thereof.

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Kidney Donation after Cardiac Death in Korea

Cited by 10 publications

References 3 publications

Kidney donation after cardiac death

Kidney donation after cardiac death

Kidney Transplantation from a Donor Following Cardiac Death Supported with Extracorporeal Membrane Oxygenation

Patients’ preferences in transplantation from marginal donors: results of a discrete choice experiment

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