Update on the results of non-heart-beating donor kidney transplants

Donors after cardiac death (DCD) could increase the organ pool. Data supports good long-term renal graft survival. However, DCDs are <10% of deceased donors in the United States, due to delayed graft function, and primary nonfunction. These complications are minimized by extracorporeal support after cardiac death (ECS-DCD). This study assesses immediate and acute renal function from different donor types. DCDs kidneys were recovered by conventional rapid recovery or by ECS, and transplanted into nephrectomized healthy swine. Warm ischemia of 10 and 30 min were evaluated. Swine living donors were controls (LVD). ECS-DCDs were treated with 90 min of perfusion until organ recovery. After procurement, kidneys were cold storage 4-6 h. Renal vascular resistance (RVR), urine output (UO), urine protein concentration (UrPr) and creatinine clearance (CrCl), were collected during 4 h posttransplantation. All grafts functioned with adequate renal blood flow for 4 h. RVR at 4 h posttransplant returned to baseline only in the LVD group (0.36 mmHg/mL/min ± 0.03). RVR was higher in all DCDs (0.66 mmHg/mL/min ± 0.13), without differences between them. UO was >50 mL/h in all DCDs, except in DCD-30 (6.8 mL/h ± 1.7). DCD-30 had lower CrCl (0.9 mL/min ± 0.2) and higher UrPr >200 mg/dL, compared to other DCDs >10 mL/min and <160 mg/dL, respectively. Normothermic ECS can resuscitate kidneys to transplantable status after 30 min of cardiac arrest/WI.

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“…When implemented, the rates of PGNF were reduced to as little as 5%. (25) The use of this technique became standard in many DCD programs. (26-28)…”

Section: Discussionmentioning

confidence: 99%

“…This method allows transplant centers to identify grafts with elevated resistance and these kidneys were simply discarded. When implemented, the rates of PGNF were reduced to as little as 5% (25). The use of this technique became standard in many DCD programs (26)(27)(28).…”

Section: Discussionmentioning

confidence: 99%

Extracorporeal Support: Improves Donor Renal Graft Function After Cardiac Death

Rojas-Pena

Reoma

Krause

et al. 2010

American Journal of Transplantation

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“…Hoshinaga et al reported that only 16.5% of renal grafts from NHBD functioned immediately after the transplantation [5]. Acute tubular necrosis was common in renal grafts from NHBD, and the incidence of delayed renal graft function was reported to be as high as 65% [6] or 50–77% [7]. Kievit et al reported that 45–50% of renal grafts from NHBD were discarded for different reasons [7].…”

Section: Discussionmentioning

confidence: 99%

“…Acute tubular necrosis was common in renal grafts from NHBD, and the incidence of delayed renal graft function was reported to be as high as 65% [6] or 50–77% [7]. Kievit et al reported that 45–50% of renal grafts from NHBD were discarded for different reasons [7]. Warm ischemic time was the most important determining factor for function of renal grafts from NHBD.…”

Section: Discussionmentioning

confidence: 99%

Extracorporeal membrane oxygenation support of donor abdominal organs in non‐heart‐beating donors

Chen

Tsai

et al. 2000

Clinical Transplantation

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Both family consent and legal consent were required for organ/tissue donation from non‐heart‐beating donors (NHBD) in Taiwan. A district attorney had to come to the bedside to confirm the donor's asystole, confirm the family consent, and complete some legal documents before a legal consent was issued for organ donation. The resultant warm ischemic time would be unpredictably long and in fact precluded the organ donation from NHBD in Taiwan. We developed a method of using extracorporeal membrane oxygenation (ECMO) to maintain NHBD for a longer time and prevent warm ischemic injury of the donor abdominal organs. After ventilator disconnection in NHBD, phentolamine and heparin were injected and mannitol infusion was given. After the donor's asystole was confirmed by the electrocardiogram (EKG) strip recording, the ECMO support was set up through the right femoral veno‐arterial route, an occlusion balloon catheter was inserted through the left femoral artery to occlude the thoracic aorta, and bilateral femoral arteries were ligated. Usually, the ECMO could begin within 10 min after the donor's asystole. The ECMO, combined with a cooler, provided cold oxygenated blood to the abdominal visceral organs, and prevented their warm ischemic injuries. Under the ECMO support (range: 45–70 min), eight renal grafts were procured from 4 NHBD. With the exception of the first two renal grafts with delayed function, all others had immediate function postoperatively and dialysis was no longer needed. In conclusion, by our ECMO technique, NHBD could be maintained for a longer time and the renal grafts had better immediate postoperative function than those reported by other methods.

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“…In 1989, an NHBD procurement and transplant program was initiated at the Hospital Clinico San Carlos, Madrid. Although the use of NHBD has increased the donor pool, the warm ischemic time for NHBD kidney harvest is inevitably longer and this influences the function of the renal grafts (1).…”

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confidence: 99%

Expanding the donor pool: use of renal transplants from non‐heart‐beating donors supported with extracorporeal membrane oxygenation

Lee¹,

Tsai²,

Ko³

et al. 2005

Clinical Transplantation

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In response to organ shortage, we used the renal grafts from non-heart-beating donors (NHBDs). Extracorporeal membrane oxygenation (ECMO) was used to maintain NHBDs before organ procurement. We compared the results of renal transplantation from different donors, including heart-beating donors (HBDs), living-related donors (LDs), and NHBDs supported with ECMO. From February 1998 to June 2003, we recruited 219 patients receiving renal transplantation at National Taiwan University Hospital. Among them, 31 received kidneys from NHBDs supported with ECMO, 120 from HBDs, and 68 from LDs. Multiple organ transplant recipients were not included in this study. We compared the graft survival, serum creatinine levels, and estimated glomerular filtration rates of the three groups. The rate of delayed graft function was higher in NHBD recipients (41.9%) than in HBD recipients (27.0%) and LD recipients (10.9%) (p = 0.003). In the NHBD group, the recipients of grafts with delayed function had significantly longer ECMO runs (63.1 +/- 3.0 min) than those without delayed function (53.7 +/- 2.5 min) (p = 0.024). Estimated glomerular filtration rate (p = 0.472) and mean serum creatinine level (p = 0.286) were not significantly different between the three groups using a longitudinal approach. The 5-yr graft survival rates for NHBD (88.4%, 95% CI: 0.680-0.962), HBD (83.2%, 95% CI: 0.728-0.899), and LD transplant recipients (89.3%, 95% CI: 0.619-0.974) were not significantly different (p = 0.239). The 5-yr patient survival rates for NHBD, HBD, and LD transplant recipients were 100, 93.0 (95% CI: 0.859-0.966) and 100% respectively. The long-term allograft survival and function of kidneys from NHBDs supported by ECMO, HBD, and LD did not differ significantly. Long ECMO running time tended to delay graft function.

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Update on the results of non-heart-beating donor kidney transplants

Cited by 18 publications

References 11 publications

Extracorporeal Support: Improves Donor Renal Graft Function After Cardiac Death

Extracorporeal Support: Improves Donor Renal Graft Function After Cardiac Death

Extracorporeal membrane oxygenation support of donor abdominal organs in non‐heart‐beating donors

Expanding the donor pool: use of renal transplants from non‐heart‐beating donors supported with extracorporeal membrane oxygenation

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