Survival Benefit of Donation After Circulatory Death Kidney Transplantation in Children Compared With Remaining on the Waiting List for a Kidney Donated After Brain Death

Abstract

The data reported here have been supplied by the Hennepin Healthcare Research Institute as the contractor for the Scientific Registry of Transplant Recipients (SRTR). The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy of or interpretation by the SRTR or the US Government. S.J.K. participated in study design, data analysis, and writing of the article. B.M.C. participated in study design and writing of the article. M.D.E. participated in data analysis and writing of the article.

Normothermic Regional Perfusion in Pediatric Controlled Donation After Circulatory Death Can Lead to Optimal Organ Utilization and Posttransplant Outcomes

“…Contrary to previous observations in which the incidence of DGF in recipients of pediatric cDCD donors was higher than in the DBD setting, 19-21 the DGF rate in our series was low, even though our mean kidney CIT was >15 h. We do think that the use of NRP might have played a key role in the reduced DGF rate as observed in adult kidney transplants, in which the use of NRP significantly decreases the incidence of DGF compared with kidneys obtained with the RR technique. 11…”

“…Our low rate of kidneys discarded and good graft survival with optimal glomerular filtration rate at 1 y might encourage the use of these kidneys also in the pediatric population, given the long waiting time for kidney transplantation in children. 7 Contrary to previous observations in which the incidence of DGF in recipients of pediatric cDCD donors was higher than in the DBD setting, [19][20][21] the DGF rate in our series was low, even though our mean kidney CIT was >15 h. We do think that the use of NRP might have played a key role in the reduced DGF rate as observed in adult kidney transplants, in which the use of NRP significantly decreases the incidence of DGF compared with kidneys obtained with the RR technique. 11 Livers from DCD donors are associated with worse posttransplant outcomes compared with DBD livers due to higher rates of biliary complications and ischemic cholangiopathy.…”

“…Pediatric kidneys obtained from DCD donors are related to higher rates of PNF and early thrombosis compared with pediatric DBD donors, 19-21 as it happened in our 2 cases who lost their grafts. However, in our study, 1-y kidney graft survival was better than what described in previous publications.…”

“…A recent publication showed that only 2.0 grafts were recovered from pediatric DCD donors, lower than our results that nearly doubled this figure. 3 Pediatric kidneys obtained from DCD donors are related to higher rates of PNF and early thrombosis compared with pediatric DBD donors, [19][20][21] as it happened in our 2 cases who lost their grafts. However, in our study, 1-y kidney graft survival was better than what described in previous publications.…”

“…However, in our study, 1-y kidney graft survival was better than what described in previous publications. 5,19 Kizilbash et al 21 showed a close relationship between a warm ischemic time (WIT) >15 min and kidney survival. This short time limit is difficult to achieve with the RR technique, as once death is declared, a laparotomy and aorta cannulation must be performed, which increases the duration of WIT.…”