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Published on: August 15, 2022
Kidney transplantation from donors after cardiac death: uncontrolled versus controlled donation
E R P Hoogland1, M G J Snoeijs, B Winkens
1Department of Surgery, Maastricht University Medical Center, The Netherlands. p.hoogland@mumc.nl
Abstract:
Kidney donation after cardiac death has been popularized over the last decade. The majority of these kidneys are from controlled donors. The number of organs for transplantation can be further increased by uncontrolled donors after cardiac death. The outcome of uncontrolled compared to controlled donor kidney transplantation is relatively unknown. We compared the long-term outcome of kidney transplantation from uncontrolled (n = 128) and controlled (n = 208) donor kidneys procured in the Maastricht region from January 1, 1981 until January 1, 2008, and transplanted in the Eurotransplant region. The incidence of primary nonfunction and delayed graft function in both uncontrolled and controlled donor kidneys is relatively high (22% vs. 21%, and 61% vs. 56%, p = 0.43, respectively). Ten-year graft and recipient survival are similar in both groups (50% vs. 46%, p = 0.74 and 61% vs. 60%, p = 0.76, respectively). Estimated glomerular filtration rates 1 year after transplantation are 40 ± 16 versus 42 ± 19 mL/min/1.73 m(2) , p = 0.55, with a yearly decline thereafter of 0.67 ± 3 versus 0.70 ± 7 mL/min/1.73 m(2) /year, p = 0.97. The outcome of kidney transplantation from uncontrolled and controlled donors after cardiac death is equivalent. This justifies the expansion of the donor pool with uncontrolled donors to reduce the still growing waiting list for renal transplantation, and may stimulate the implementation of uncontrolled kidney donation programs.
Insights
Kidney transplantation outcomes from uncontrolled donors after cardiac death are equivalent to those from controlled donors. This finding supports expanding the donor pool with uncontrolled donors to shorten renal transplantation waiting lists.
Area of Science:
- Nephrology
- Transplantation Surgery
- Organ Donation
Background:
- Kidney donation after cardiac death (DCD) has increased, primarily from controlled donors.
- The use of uncontrolled DCD kidneys for transplantation remains less explored.
- Expanding the donor pool is crucial to address the growing waiting list for renal transplantation.
Purpose of the Study:
- To compare the long-term outcomes of kidney transplantation from uncontrolled versus controlled DCD donors.
- To evaluate the feasibility of increasing organ availability through uncontrolled DCD programs.
Main Methods:
- Retrospective analysis of kidney transplants from uncontrolled (n=128) and controlled (n=208) DCD donors.
- Procurement in the Maastricht region and transplantation within the Eurotransplant region (1981-2008).
- Comparison of primary nonfunction, delayed graft function, graft survival, recipient survival, and estimated glomerular filtration rates (eGFR).
Main Results:
- Similar rates of primary nonfunction (22% vs. 21%) and delayed graft function (61% vs. 56%) were observed.
- Ten-year graft survival (50% vs. 46%) and recipient survival (61% vs. 60%) were comparable between groups.
- One-year eGFR and subsequent annual decline were not significantly different between uncontrolled and controlled DCD kidney recipients.
Conclusions:
- Kidney transplantation outcomes from uncontrolled and controlled DCD donors are equivalent.
- Uncontrolled DCD kidney donation programs can be implemented to expand the donor pool.
- This strategy can help reduce waiting times for renal transplantation.
Related Concept Videos
01:28Kidney Transplant I: Introduction
01:26Kidney Transplant II: Surgical Procedure