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Outcome of Kidney Transplantation in Israel Following Uncontrolled Donation after Cardiocirculatory Determination of
Jonathan D Cohen1, Tomer Kaplan2, Tammy Fink3
1MBBCh FCP (SA).
Insights
Kidney transplants from uncontrolled donation after cardiocirculatory determination of death (uDCDD) show promising results, with 90% graft survival at one year. Expanding this program could significantly reduce organ transplant waiting lists.
Area of Science:
- Nephrology
- Transplantation Medicine
- Emergency Medical Services
Background:
- A pilot program for kidney donation from uncontrolled donation after cardiocirculatory determination of death (uDCDD) was established in Israel.
- This initiative involved four hospitals and Magen David Adom (MDA), the national emergency medical service.
Purpose of the Study:
- To evaluate the outcomes of kidney transplantations performed between January 2017 and June 2022.
- To assess the viability of using out-of-hospital cardiac arrest cases as potential uDCDD donors.
Main Methods:
- Retrospective analysis of donor and recipient data, including demographics and serum creatinine levels.
- Review of out-of-hospital cardiac arrest cases managed by MDA in 2021 to identify potential uDCDD donors.
- Assessment of transplant success rates and graft survival at various follow-up intervals.
Main Results:
- Out of 49 potential donors referred, consent was obtained in 83% (40 cases), with 40 kidneys transplanted from 21 donors (75% retrieval rate).
- One-year graft survival was 90%, with a mean serum creatinine of 1.59 mg%.
- Long-term follow-up showed stable graft function, with mean serum creatinine levels remaining below 1.5 mg% up to 5 years post-transplant.
Conclusions:
- Transplant outcomes from the uDCDD program are encouraging.
- Increased implementation of the uDCDD program could enhance kidney transplantation rates.
- Expanding the program has the potential to decrease waiting times for kidney transplant recipients.
Background:
A limited program for kidney donation from uncontrolled donation after cardiocirculatory determination of death (uDCDD) was implemented at four hospitals in Israel in close cooperation with Magen David Adom (MDA), the national emergency medical service.
Objectives:
To assess the outcome of transplantations performed between January 2017 and June 2022.
Methods:
Donor data included age, sex, and cause of death. Recipient data included age, sex, and yearly serum creatinine levels. A retrospective study of out-of-hospital cardiac arrest cases treated by MDA during 2021 were analyzed to assess their compatibility as potential uDCDD donors.
Results:
In total, 49 potential donors were referred to hospitals by MDA. Consent was obtained in 40 cases (83%), organ retrieval was performed in 28 cases, and 40 kidneys were transplanted from 21 donors (75% retrieval rate). At 1-year follow-up, 36 recipients had a functioning graft (4 returned to dialysis) and mean serum creatinine 1.59 ± 0.92 mg% (90% graft survival). Outcome after transplantation showed serum creatinine levels (mg%) at 2 years 1.41 ± 0.83, n=26; 3 years 1.48 ± 0.99, n=16; 4 years 1.07 ± 1.06, n=7; and 5 years 1.12 ± 0.31, n=5. One patient died of multiple myeloma at 3 years. The MDA audit revealed an unutilized pool of 125 potential cases, 90 of whom were transported to hospitals and 35 were declared dead at the scene.
Conclusions:
Transplant outcomes were encouraging, suggesting that more intensive implementation of the program may increase the number of kidneys transplanted, thus shortening recipient waiting lists.
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01:26Kidney Transplant II: Surgical Procedure
01:16Kidney Transplant III: Nursing Management
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