[Kidney donors after circulatory death (DCD) - single centre experience]

Area of Science:

• Transplantation Medicine
• Nephrology
• Organ Donation

Background:

• Donors after circulatory death (DCD) represent a critical source for organ transplantation worldwide.
• The Czech Republic initiated DCD kidney transplantation in 2002.
• Procurement protocols for DCD kidneys have evolved to optimize graft viability.

Purpose of the Study:

• To evaluate the outcomes of kidney transplantation using organs from donors after circulatory death.
• To assess the long-term viability and survival rates of DCD kidney grafts.
• To compare DCD kidney transplant results with those from donors after brain death.

Main Methods:

• Procurement of 44 DCD kidneys between 2002 and 2015 using "in situ" technique and a double balloon triple lumen catheter.
• Application of a 5-10 minute "no-touch" interval post-mortem.
• Assessment of kidney viability through pulsatile hypothermic perfusion prior to transplantation.
• Transplantation of 28 kidneys into recipients with a mean age of 51.1 years.
• Categorization of DCD donors based on Maastricht criteria (II, III, and IV).

Main Results:

• Zero 30-day mortality and low morbidity (10.7%).
• Primary non-function rate of 7.1% and delayed graft function in 17.9% of cases.
• Excellent long-term recipient survival rates: 100% at 1 year, 86.4% at 5 years, and 76.7% at 10 years.
• Comparable graft survival rates: 92.9% at 1 year, 69.6% at 5 years, and 61.9% at 10 years.
• Outcomes are comparable to kidneys from donors after brain death.

Conclusions:

• Kidney transplantation from donors after circulatory death (DCD) is a highly effective strategy.
• DCD kidneys are a vital and viable source for increasing organ transplant capacity.
• Despite logistical and resource demands, DCD kidney transplantation yields very good long-term results.