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

Abstract

Background. Organ shortage persists despite a high rate of donation after circulatory death (DCD) in the Netherlands. The median waiting time for a deceased donor kidney in 2013 was 3.5 years. Most DCD kidneys are from controlled DCD (cDCD; Maastricht category III). Experience with uncontrolled donors after cardiac death (uDCD), that is, donors with an unexpected and irreversible cardiac arrest (Maastricht categories I and II), is increasing; and its effect on transplant outcomes needs evaluation. Methods. We used the Dutch Organ Transplantation Registry to include recipients (≥18 years old) from all Dutch centers who received transplants from 2002 to 2012 with a first DCD kidney. We compared transplant outcome in uDCD (n = 97) and cDCD (n = 1441). Results. Primary nonfunction in uDCD was higher than in the cDCD (19.6% vs 9.6%, P < 0.001, respectively). Delayed graft function was also higher in uDCD than in cDCD, but not significantly (73.7% vs 63.3%, P = .074, respectively). If censored for primary nonfunction, estimated glomerular filtration rates after 1 year and 5 years were comparable between uDCD and cDCD (1 year: uDCD, 44.3 (23.4) mL/min/m 2 and cDCD, 45.8 (24.1) mL/min/m

Improving the Outcomes of Organs Obtained From Controlled Donation After Circulatory Death Donors Using Abdominal Normothermic Regional Perfusion

“…In a recent Dutch study, with 1441 recipients who received a first cDCD donor kidney, the rate of PNF was 9.6% (vs. 5.4% in our series) and that of DGF was 63.4% (vs. 27% in our series) . Another large research study with >2000 kidneys transplanted from cDCD donor showed a PNF rate of 5% and a DGF rate of 50.2% .…”

Proteins in Preservation Fluid as Predictors of Delayed Graft Function in Kidneys from Donors after Circulatory Death

“…Patients in the DGF group underwent 1 to .36 dialysis sessions (median 3) after transplantation. The incidence of DGF in the verification set is 67.5%, in line with the reported incidence of DGF of 63.4% in controlled DCD kidney recipients in The Netherlands (25). At 12 months, overall survival in the IF group was 92.3%, and 81.5% in the DGF group.…”

Strict selection criteria in uncontrolled donation after circulatory death provide excellent long‐term kidney graft survival

“…PNF is the main concern in uDCD kidney transplantation with a reported incidence ranging from 1.8% to 20% in the largest series. [11][12][13][14]16,25 Several factors such as donor age, prolonged WIT, or in situ cooling as preservation method have been related to high rates of PNF. 12,13,16 The primary reasons for our excellent results are most likely the strict admission criteria, keeping intrahospital logistics as simple as possible to minimize the WIT.…”

“…8 In terms of the outcomes obtained using organs procured from uDCD donors, excellent long-term kidney graft survival has been reported from uDCD procedures. 9,10 However, there is still some reluctance toward the use of uDCD kidneys due to higher rate of primary nonfunction (PNF) [11][12][13] and increased incidence of delayed graft function (DGF). High kidney discard rates also remain a challenge that lower the conversion rates of potential into utilized donors.…”