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Published on: October 11, 2014
Short-term evolution of renal transplant with grafts from donation after cardiac death: Type III Maastricht category
M D Salmeron-Rodriguez1, M D Navarro-Cabello1, M L Agüera-Morales1
1Department of Nephrology, Hospital Universitario Reina Sofía, Córdoba, Spain.
Insights
Kidney transplants from donors after cardiac death (DCD) show favorable short-term outcomes. This DCD kidney transplant approach offers a promising alternative for end-stage renal disease patients.
Area of Science:
- Nephrology
- Transplantation Surgery
- Organ Donation
Background:
- Kidney transplantation is a vital treatment for end-stage renal failure.
- Donors after cardiac death (DCD), specifically Maastricht Type III, represent a potential organ source.
- Evaluating the outcomes of DCD kidney transplants is crucial for expanding donor pools.
Purpose of the Study:
- To assess the short-term outcomes of kidney transplantation using organs from DCD (Maastricht Type III) donors.
- To analyze graft function and recipient recovery in the first six months post-transplant.
Main Methods:
- A cohort study involving 8 kidney transplant recipients from DCD donors.
- Analysis of donor and recipient demographics, ischemia times, and pre-implantation biopsy results.
- Monitoring of graft function, including delayed graft function and creatinine levels, for six months post-transplantation.
Main Results:
- The study included 8 kidney transplants from DCD donors (Maastricht Type III).
- Mean donor age was 58.4 years, mean recipient age was 59.9 years; 87.5% of recipients were male.
- 75% of recipients experienced delayed graft function requiring dialysis; mean creatinine levels improved from 2.37 mg/dL at 1 month to 1.17 mg/dL at 6 months.
Conclusions:
- Kidney transplantation utilizing Maastricht Type III DCD grafts demonstrates favorable short-term evolution.
- Controlled asystole donation presents a viable alternative strategy to increase kidney transplantation rates.
Background:
Kidney transplantation from donors after cardiac death (Type III Maastricht category) is a therapeutic option for patients with terminal renal failure.
Materials And Methods:
We present a cohort of 8 patients who received a kidney transplant from donors after cardiac death (DCD). We analyzed the analytical results for the first 6 months after transplantation.
Results:
We included 8 cases of kidney transplants with organs from DCD (Type III Maastricht category). The mean age of donors was 58.40 ± 4.39 years and 3 (60%) were male. The mean creatinine (Cr) level prior to death was 1.10 ± 0.36 mg/dL. The mean age of recipients was 59.88 ± 10.58 years and 7 (87.5%) were male. Seven patients (87.5%) were on hemodialysis, whereas only 1 (12.5%) was on peritoneal dialysis. The median time on renal replacement therapy was 18 months (range, 2-76). Mean total warm ischemia time (WIT) was 24.88 ± 6.72 minutes, whereas the mean real WIT was 20.13 ± 4.51 minutes. The mean cold ischemia time (CIT) was 6 hours and 12 minutes ± 2 hours. Preimplantation biopsy showed acute tubular necrosis (extensive 40%). Tubular atrophy was mild in 100% of cases. After transplantation, 6 patients (75%) had delayed graft function requiring dialysis sessions whereas 2 patients (25%) did not require renal replacement therapy. Mean Cr level at 1, 3, and 6 months after transplantation was 2.37, 1.75, and 1.17 mg/dL, respectively.
Conclusion:
Kidney transplantation with grafts from donors after cardiac arrest Maastricht Type III evolves favorably in the short term. According to preliminary results, controlled asystole donation could be an effective alternative to transplantation.
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