Uncontrolled donation after circulatory death: comparison of two kidney preservation protocols on graft outcomes

Abstract

BackgroundKidney transplantation following uncontrolled donation after circulatory death (uDCD) presents a high risk of delayed graft function due to prolonged warm ischemia time. In order to minimise the effects of ischemia/reperfusion injury during warm ischemia, normothermic recirculation recently replaced in situ perfusion prior to implantation in several institutions. The aim of this study was to compare these preservation methods on kidney graft outcomes.MethodsThe primary endpoint was the one-year measured graft filtration rate (mGFR). We collected retrospective data from 64 consecutive uDCD recipients transplanted over a seven-year period in a single centre.ResultsThirty-two grafts were preserved by in situ perfusion and 32 by normothermic recirculation. The mean ± SD mGFR at 1 year post-transplantation was 43.0 ± 12.8 mL/min/1.73 m2 in the in situ perfusion group and 53.2 ± 12.8 mL/min/1.73 m2 in the normothermic recirculation group (p = 0.01). Estimated GFR levels were significantly higher in the normothermic recirculation group at 12 months (p = 0.01) and 24 months (p = 0.03) of follow-up. We did not find any difference between groups regarding patient and graft survival, delayed graft function, graft rejection, or interstitial fibrosis.ConclusionsFunction of grafts preserved by normothermic recirculation was better at 1 year and the results suggest that this persists at 2 years, although no difference was found in short-term outcomes. Despite the retrospective design, this study provides an additional argument in favour of normothermic recirculation.Electronic supplementary materialThe online version of this article (10.1186/s12882-017-0805-1) contains supplementary material, which is available to authorized users.

Donation after circulatory death today: an updated overview of the European landscape

“…Recent literature on the topic reveals that nRP can substantially reduce the incidence of PNF among uDCD kidney transplants, compared with the in situ cooling of kidneys . The function of uDCD kidneys subject to nRP is also better . In fact, large series of uDCD kidneys show extraordinary outcomes with this approach .…”

Use of ex vivo normothermic machine perfusion after normothermic regional perfusion to salvage a poorly perfused DCD kidney

“…Less is known about the effects of NRP on renal transplant outcomes. However, a large recent nonrandomized study showed that there was no statistically significant difference in the rates of delayed graft function in kidneys preserved by cold storage compared with the use of NRP …”

Abdominal Normothermic Regional Perfusion in Donation After Circulatory Death: A Systematic Review and Critical Appraisal

“…van de Leemkolk et al abdominal organs included in the studies concerned: kidney (n = 9), 24,[26][27][28]34,36,37,41,45 liver (n = 11), 21,25,29,31,32,39,40,[42][43][44]46 kidney and liver (n = 1), 30 and kidney, liver, and pancreas/islets (n = 3). 33,35,38 The overlap in partly duplicate reporting on the same organ is outlined in Table 2.…”