Lessons learned from a single center's experience with 134 donation after cardiac death donor kidney transplants

Area of Science:

• Nephrology
• Transplantation Surgery
• Organ Donation

Background:

• Donation after cardiac death (DCD) kidney transplants are associated with high rates of delayed graft function (DGF).
• Strategies to mitigate DGF are crucial for improving transplant outcomes and expanding the donor pool.

Purpose of the Study:

• To evaluate the impact of extracorporeal interval support for organ retrieval (EISOR) on kidney transplant outcomes from DCD donors.
• To compare the outcomes of standard-criteria (SCD) versus expanded-criteria (ECD) DCD donor kidney transplants.

Main Methods:

• A retrospective analysis of 134 kidney transplants from DCD donors between April 2003 and October 2010.
• Comparison of outcomes between kidneys managed with and without EISOR, including DGF rates, graft survival, and hospitalization duration.
• Subgroup analysis of SCD and ECD DCD donor kidneys.

Main Results:

• EISOR use was associated with a significant reduction in DGF (21% vs. 55%, p=0.016) and improved graft resistance on machine perfusion.
• Kidneys from DCD standard-criteria donors demonstrated excellent 1, 3, and 5-year graft survival rates (89%, 76%, 76%).
• Kidneys from DCD expanded-criteria donors had significantly inferior 1 and 3-year graft survival rates (58% and 48%) compared to non-ECD grafts (90% and 79%, p=0.013).

Conclusions:

• EISOR is a valuable technique for reducing DGF and improving early graft function in DCD kidney transplantation.
• Standard-criteria DCD donor kidneys offer excellent medium-term outcomes and are vital for increasing organ availability.
• Expanded-criteria DCD donor kidneys yield inferior results and require careful consideration.