Non-Heart-Beating Kidney Transplantation: 6-Year Outcomes

Sanni, Aliu; Wilson, CH; Wyrley-Birch, H; Vijayanand, D; Navarro, Alex; Gok, MA; Sohrabi, Soroush; Jaques, BC; Rix, D.; Soomro, NA; Manas, DM; Talbot, David

doi:10.1016/j.transproceed.2006.10.108

Cited by 18 publications

(13 citation statements)

References 5 publications

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“…Patient survival and long-term graft function have been demonstrated to be equivalent in HBD and NHBD [2]. There is no difference for one year allograft survival and renal function is similar even after six years [29,30]. Thus, the high delayed graft function rate we observed (92%) was in accordance with the literature concerning uncontrolled NHBD [29,31].…”

Section: Discussionsupporting

confidence: 88%

Kidney retrieval after sudden out of hospital refractory cardiac arrest: a cohort of uncontrolled non heart beating donors

et al. 2009

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Introduction To counter the shortage of kidney grafts in France, a non heart beating donor (NHBD) program has recently been implemented. The aim of this study was to describe this pilot program for kidney retrieval from "uncontrolled" NHBD meaning those for whom attempts of resuscitation after a witnessed outof-hospital cardiac arrest (CA) have failed (Maastricht 1 and 2), in a centre previously trained for retrieval from brain dead donors.

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Section: Discussionsupporting

confidence: 88%

Kidney retrieval after sudden out of hospital refractory cardiac arrest: a cohort of uncontrolled non heart beating donors

et al. 2009

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“…Treatment consisted of Solumedrol and the patient with a second rejection episode received ATG to treat the second rejection. This percentage is much lower than reported in previous studies after kidney transplantation from DCD donors [23,24], which is probably because of the inclusion of kidney transplantations from uncontrolled DCD donors in these studies for whom higher rejection rates are reported [25], the inclusion of rejection episodes over a longer period of time (while rejections were only included in this study when they occurred during the initial hospitalization) and the fact that 88% of the transplantations in this study were first transplantations so that these patients were probably less immunized and therefore had lower risk of rejection. Patients with urological complications on average were 10 years older than patients without urological complications, but did not differ in any of the other characteristics ( Table 2).…”

Section: Complicationscontrasting

confidence: 64%

Urological complications and their impact on survival after kidney transplantation from deceased cardiac death donors

Khairoun

Barański

Boog

et al. 2008

Transplant International

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Summary Urological complications after kidney transplantation may result in significant morbidity and mortality. However, the incidence of such complications after deceased cardiac death (DCD) donor kidney transplantation and their effect on survival is unknown. Purpose of this study was to estimate the incidence of urological complications after DCD kidney transplantation, and to estimate their impact on survival. Patient records of all 76 DCD kidney transplantations in the period 1997–2004 were reviewed for (urological) complications during the initial hospitalization until 30 days after discharge, and graft survival until the last hospital visit. Urological complications occurred in 32 patients (42.1%), with leakage and/or obstruction occurring in seven patients (9.2%). The latter seems to be comparable with the incidence reported in the literature for deceased heart‐beating (DHB) transplantations (range 2.5–10%). Overall graft survival was 92% at 1 year and 88% at 3 years, comparable to the rates reported in the literature for kidneys from DHB donors, and was not affected by urological complications (χ2 = 0.27, P = 0.61). Only a first warm‐ischaemia time of 30 min or more reduced graft survival (χ2 = 4.38, P < 0.05). We conclude that urological complications occur frequently after DCD kidney transplantation, but do not influence graft survival. The only risk factor for reduced graft survival in DCD transplant recipients was the first warm‐ischaemia time.

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“…The DCD grafts in this study by all accounts appeared to have been of high quality, predominantly having short warm ischemia time and coming from younger donors. This finding was unexpected because late graft loss in DCD kidney transplants has not been described in adult recipients (5)(6)(7)(8)(9)(10)(11)(12), nor was it identified in a previous analysis of pediatric recipients (15). Our ability to detect this difference is likely due to a substantial increase in power (from 26 DCD recipients in the previously largest study to 137 DCD recipients in this study) and follow-up time.…”

Section: Discussionmentioning

confidence: 54%

“…In adults, DCD kidneys seem to result in similar graft and patient survival compared with donation after brain death (DBD) kidneys (5)(6)(7)(8)(9)(10)(11)(12). However, DCD kidneys also have a significantly higher rate of delayed graft function (DGF) compared with DBD kidneys (5,(7)(8)(9)(10)(11)(12).…”

Section: Introductionmentioning

confidence: 99%

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Late Graft Loss among Pediatric Recipients of DCD Kidneys

Arendonk

James

Locke

et al. 2011

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Kidney transplantation from donors after cardiac death (DCD) provides similar graft survival to donors after brain death (DBD) in adult recipients. However, outcomes of DCD kidneys in pediatric recipients remain unclear, primarily because of limited sample sizes.Design, setting, participants, & measurements We identified 137 pediatric (Ͻ18 years old) recipients of DCD kidneys between 1994 and 2010 using Scientific Registry of Transplant Recipients data and compared outcomes with 6059 pediatric recipients of DBD kidneys during the same time period, accounting for donor, recipient, and transplant characteristics using time-varying Cox regression and matched controls. Long-term follow-up (4 years or beyond) was available for 31 DCD recipients.Results Pediatric recipients of DCD kidneys experienced a significantly higher rate of delayed graft function (22.0% versus 12.3%; P ϭ 0.001), although lower than reported delayed graft function rates of DCD grafts in adults. Although DCD and DBD graft survival was equal in the early postoperative period, graft loss among pediatric recipients of DCD kidneys exceeded their DBD counterparts starting 4 years after transplantation. This effect was statistically significant in a multivariate Cox model (hazard ratio ϭ 2.03; 95% confidence interval, 1.21 to 3.39; P ϭ 0.007) and matched-controls analysis (hazard ratio ϭ 2.36; 95% confidence interval, 1.11 to 5.03; P ϭ 0.03).Conclusions A significant increase in DCD graft loss starting 4 years after transplantation motivates a cautious approach to the use of DCD kidneys in children, in whom long-term graft survival is of utmost importance.

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Non-Heart-Beating Kidney Transplantation: 6-Year Outcomes

Cited by 18 publications

References 5 publications

Kidney retrieval after sudden out of hospital refractory cardiac arrest: a cohort of uncontrolled non heart beating donors

Kidney retrieval after sudden out of hospital refractory cardiac arrest: a cohort of uncontrolled non heart beating donors

Urological complications and their impact on survival after kidney transplantation from deceased cardiac death donors

Late Graft Loss among Pediatric Recipients of DCD Kidneys

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