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Nonutilization of Kidneys From Donors After Circulatory Determinant of Death
Yingxin Lin1,2, Armando Teixeira-Pinto1,3, Helen Opdam4
1Sydney School of Public Health, University of Sydney, Sydney, Australia.
Insights
Kidney utilization from donation after circulatory determination of death (DCDD) donors can be improved. Donor kidney function and warm ischemia time are key factors influencing nonutilization, impacting kidney transplantation success.
Area of Science:
- Nephrology
- Transplantation Surgery
- Organ Donation
Background:
- Donation after circulatory determination of death (DCDD) programs are expanding.
- There is a significant unmet demand for kidney transplantation.
- Improving organ utilization from DCDD donors is crucial.
Purpose of the Study:
- To identify factors associated with kidney nonutilization from DCDD donors.
- To analyze DCDD donor characteristics and their impact on organ viability.
- To enhance kidney transplantation efficiency.
Main Methods:
- Analysis of all DCDD donors retrieved for kidney transplantation in Australia (2014-2019).
- Utilized least absolute shrinkage and selection operator (LASSO) and random forest models to determine nonutilization factors.
- Employed self-organizing maps (SOM) to cluster donors and identify key characteristics.
Main Results:
- 15% (116 of 762) of DCDD donors were not utilized for kidney transplantation.
- Two donor clusters identified with the highest proportions of nonutilized kidneys.
- Key factors for nonutilization included longer warm ischemia time and poorer donor kidney function (terminal serum creatinine).
Conclusions:
- Donor terminal kidney function and warm ischemia duration are primary determinants of DCDD kidney nonutilization.
- Strategies to minimize warm ischemia time and enhance post-transplant kidney function are essential.
- Reducing nonutilization rates can increase the availability of DCDD kidneys for transplantation.
Background:
The expansion of donation after circulatory determination of death (DCDD) programs and unmet demands for kidney transplantation indicate that there is a need to improve the efficiency and utilization of these organs.
Methods:
We studied all DCDD donors retrieved for kidney transplantation in Australia between 2014 and 2019 and determined the factors associated with nonutilization using least absolute shrinkage and selection operator and random forest models. Self-organizing maps were used to group these donors into clusters with similar characteristics and features associated with nonutilization were defined.
Results:
Of the 762 DCDD donors, 116 (15%) were not utilized for kidney transplantation. Of the 9 clusters derived from self-organizing map, 2 had the highest proportions of nonutilized kidneys. Factors for nonutilization (adjusted odds ratio [95% confidence interval], per SD increase) were duration from withdrawal of cardiorespiratory support till death (1.38 [1.16-1.64]), admission and terminal serum creatinine (1.43 [1.13-1.85]) and (1.41 [1.16-1.73]). Donor kidney function and duration of warm ischemia were the main factors for clinical decisions taken not to use kidneys from DCDD donors.
Conclusions:
Donor terminal kidney function and the duration of warm ischemia are the key factors for nonutilization of DCDD kidneys. Strategies to reduce the duration of warm ischemia and improve post-transplant recipient kidney function may reduce rates of nonutilization.
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