Kidneys from uncontrolled donors after cardiac death: which kidneys do worse?

Abstract

SummaryKidneys from uncontrolled donors after cardiac death (DCD) expand the donor pool, but are associated with more primary nonfunction (PNF) and delayed graft function (DGF) compared with more conventional donor kidneys. It remains unclear, which factors influence outcome of uncontrolled donation. Therefore, we studied which donor, graft, and recipient characteristics are associated with PNF in a large cohort study. The association between different characteristics and short-term graft function was analyzed for kidneys procured in the Maastricht region from 1 January 1981 to 1 July 2009. Patients were followed until 7 January 2010. A total of 135 uncontrolled donor kidneys were included in this study. The incidence of PNF and DGF was 22% and 61%, respectively. Increasing donor age is an independent risk factor for graft failure in a univariate analysis (OR 1.035, 95% CI 1.004-1.068, P = 0.028). Donor age remains strongly associated with PNF in a multivariate analysis (OR 1.064, 95% CI 1.013-1.118, P = 0.014). However, the predictive value of donor age alone is poor (AURC 0.640, 95% CI 0.553-0.721). Increasing donor age of uncontrolled DCD donors is a major risk factor for PNF. Other clinically relevant variables were not associated with PNF. Donor age is strongly associated with PNF and remains an important parameter in donor selection.

Similar 5-Year Estimated Glomerular Filtration Rate Between Kidney Transplants From Uncontrolled and Controlled Donors After Circulatory Death—A Dutch Cohort Study

“…7 In our cohort, roughly 60 uDCD kidneys and 170 cDCD were machine perfused between 2002 and 2012. Management of machine perfusion of DCD was done as described by Hoogland et al 4,7 Viability testing was not used to determine organ suitability.…”

“…However, lately, there has been growing interest in the potential of uDCD kidneys. 4-7 In some European countries like Spain and France, transplantation with uDCD kidneys is a more common practice, and promising results with uDCD have been reported. 8-15 After the pioneering work of the Maastricht Transplantation Center, the practice of transplanting uDCD kidneys has been implemented throughout all Dutch transplant centers.…”

Advances in Kidney Preservation Techniques and Their Application in Clinical Practice

“…Pieter Hoogland et al 8 reported the outcome of the earliest series of uDCD kidney transplants (n = 135) from 1981 to 2009 in the Netherlands: the DGF rate was 61% and the PNF rate 22%. All kidneys were flushed in situ with HTK solution and the majority preserved by HMP with Belzer UW solution from 1985.…”

“…Evidence from the United States, Australia, the United Kingdom, and Europe has demonstrated that shipping kidneys is safe with CITs of up to 16 h. However, this increases the risk of DGF, which may reduce graft and patient survival and increase incidences of acute rejection. 12,[34][35][36][37] Deceased Donor Kidney Transplantation Rates of DGF in deceased donor kidney transplantation range from 10% in standard donation after brain death (DBD) kidneys to 93% in uDCD 4,7,8,10,[16][17][18][19][20][21][22][23]27,38 (Table 1). The outcomes of graft and patient survival at 1 y are good but slightly lower in comparison to living donor kidneys.…”

“…5,6 The use of uncontrolled DCD (uDCD) donors is also increasing, with firmly established programs in several European countries. 7,8 ECD, controlled DCD (cDCD), and uDCD kidneys are all particularly susceptible to CI. [9][10][11] Efforts are made to limit the preservation interval where possible.…”