The Trouble With Kidneys Derived From the Non Heart-Beating Donor: A Single Center 10-Year Experience1

Kirby, John A.; Griffiths, Paul; Manas, Derek; Snowden, Chris; Balupuri, S.; Buckley, P.; Sen, Mmb; Hannon, M; Talbot, D

doi:10.1097/00007890-200003150-00029

Cited by 103 publications

(55 citation statements)

References 11 publications

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“…This has been most useful in Maastricht Category II donor kidneys as the viability of kidneys from Maastricht Category III and IV donors is usually good [3,11]. In this study, we used machine perfusion data primarily from Maastricht Category III DCD kidneys that have been transplanted to assess the relationship between these measurements and longer term graft survival and function.…”

Section: Discussionmentioning

confidence: 99%

“…Transplantation is the most effective treatment for end stage renal disease providing a significant survival advantage over dialysis [2], however, the demand for kidney transplantation outstrips the supply of organs. Decreased numbers of donation after brain death (DBD) kidneys has led to increased interest in donation after cardiac death (DCD) kidney transplantation [3]. In 2007, only 9 countries performed DCD transplantation, performing 778 transplants, but by 2014 this number had increased to 11 countries transplanting 3401 DCD kidneys [4,5].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Ex Vivo Perfusion Characteristics of Donation After Cardiac Death Kidneys Predict Long-Term Graft Survival

Sevinc¹,

Stamp

Carter

et al. 2016

Transplantation Proceedings

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Ex Vivo Perfusion Characteristics of Donation After Cardiac Death Kidneys Predict Long-Term Graft Survival

Sevinc¹,

Stamp

Carter

et al. 2016

Transplantation Proceedings

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“…Since August 1998, the Newcastle perfusion system has been utilised to perfuse and assess kidney viability in 41 NHBD kidneys, the outcome of which has been described [3]. In summary, 28 NHBD kidneys were transplanted locally and 11 discarded for the following reasons: 2 due to positive serology for syphilis in the donor, 4 had raised tGST, 1 did not perfuse on retrieval, and 4 had poor flow characteristics.…”

Section: Resultsmentioning

confidence: 99%

Machine perfusion for kidneys: how to do it at minimal cost

Balupuri¹,

Hoernich²,

Mohamed³

et al. 2001

Transplant Int

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Due to a shortage of organs for transplantation, many centres use marginal grafts to increase their donor pool. As kidneys from non-heart-beating donors (NHBD) have sustained initial ischaemic damage, their viability is difficult to predict. Hypothermic pulsatile perfusion has not only been used to improve the condition of such grafts, but also allows viability assessment. Suitable systems are becoming more readily available, but they are expensive. We have used existing dialysis equipment with modified sterilised inserts to create a pulsatile hypothermic perfusion system. With this system, 41 NHBD kidneys were perfused for up to 8 h; their intravascular renal resistance (IRVR), flow characteristics as well as glutathione S transferase (GST) measurements were performed to assess viability. This hypothermic pulsatile perfusion system is now an integral component of our NHBD programme.

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“…Machine perfusion has been shown to be beneficial for ECD kidneys [88] , but the results from a United Kingdom based trial comparing machine perfusion with cold storage were equivocal [89] . The effect of machine perfusion on DCD kidneys may decrease DGF by up to 38% but has no effect on longterm function [6,90] . The use of pulsatile machine perfusion decreased the incidence of DGF only when donor age was > 60 years and improved long-term graft survival when donor age was > 50 years.…”

Section: Kidney Preservation and Machine Perfusionmentioning

confidence: 99%

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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The Trouble With Kidneys Derived From the Non Heart-Beating Donor: A Single Center 10-Year Experience1

Cited by 103 publications

References 11 publications

Ex Vivo Perfusion Characteristics of Donation After Cardiac Death Kidneys Predict Long-Term Graft Survival

Ex Vivo Perfusion Characteristics of Donation After Cardiac Death Kidneys Predict Long-Term Graft Survival

Machine perfusion for kidneys: how to do it at minimal cost

Kidney donation after cardiac death

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