Renovascular resistance of machine-perfused DCD kidneys is associated with primary nonfunction

Donation after cardiac death (DCD) has shown to be a valuable extension of the donor pool despite a higher percentage of primary nonfunction (PNF). Limiting the incidence of PNF is of vital importance. Renovascular resistance is believed to predict graft outcome; however the literature is inconsistent. Therefore, we studied whether renovascular resistance is associated with PNF and whether this parameter should be used to discard donor kidneys. All transplanted DCD kidneys preserved by machine perfusion at our center between 1993 and 2007 were analyzed (n = 440). The effects of renovascular resistance on PNF, delayed graft function (DGF), and graft and patient survival were examined using multivariable analyses; predictive quality by calculating the area under the curve (AUC). We showed that renovascular resistance at the start of machine perfusion was significantly and independently associated with PNF (OR 2.040, 95% CI 1.362-3.056; p = 0.001), and DGF (OR 2.345, 95% CI 1.110-4.955; p = 0.025). Predictive quality was moderate (0.609, 95% CI 0.538-0.681). Graft and patient survival were not associated with renovascular resistance. We conclude that renovascular resistance in DCD kidneys is an independent risk factor for PNF; however, the predictive value is relatively low.