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Updated: Jul 3, 2025
Lung Rapid Recovery Procurement Combined with Abdominal Normothermic Regional Perfusion in Controlled Donation after Circulatory Death
Published on: August 15, 2022
Kidney Transplantation Outcomes From Uncontrolled Donation After Circulatory Death: A Systematic Review and
Keshini Vijayan1, Hugh J Schroder1, Ahmer Hameed1,2
1Westmead Clinical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, NSW, Australia.
Insights
Uncontrolled donation after circulatory death (uDCD) kidney transplants show higher short-term risks but comparable long-term graft survival to controlled donation after circulatory death (cDCD). Normothermic regional perfusion may improve uDCD outcomes.
Area of Science:
- Nephrology
- Transplantation immunology
- Organ donation
Background:
- Uncontrolled donation after circulatory death (uDCD) presents a potential source for additional donor kidneys.
- This study evaluates kidney transplant outcomes from uDCD compared to controlled donation after circulatory death (cDCD).
Approach:
- A systematic review and meta-analysis of nine cohort studies involving 2178 uDCD kidney transplants.
- Data on demographic information and transplant outcomes were extracted and analyzed using risk ratios (RR).
Key Points:
- Higher median incidence of primary nonfunction (12.3% vs 5.7%) and delayed graft function (65.1% vs 52.0%) observed in uDCD compared to cDCD.
- Median 1-year graft survival was lower for uDCD (82.7%) versus cDCD (87.5%), but 5-year survival was comparable (70% for both).
- Normothermic regional perfusion demonstrated potential to improve primary nonfunction rates in uDCD grafts.
Conclusions:
- While short-term outcomes for uDCD kidney transplants may be inferior, long-term graft survival appears comparable to cDCD.
- uDCD represents a viable option for increasing kidney transplant availability, particularly with strategies to mitigate initial risks.
Background:
Uncontrolled donation after circulatory death (uDCD) is a potential additional source of donor kidneys. This study reviewed uDCD kidney transplant outcomes to determine if these are comparable to controlled donation after circulatory death (cDCD).
Methods:
MEDLINE, Cochrane, and Embase databases were searched. Data on demographic information and transplant outcomes were extracted from included studies. Meta-analyses were performed, and risk ratios (RR) were estimated to compare transplant outcomes from uDCD to cDCD.
Results:
Nine cohort studies were included, from 2178 uDCD kidney transplants. There was a moderate degree of bias, as 4 studies did not account for potential confounding factors. The median incidence of primary nonfunction in uDCD was 12.3% versus 5.7% for cDCD (RR, 1.85; 95% confidence intervals, 1.06-3.23; P = 0.03, I 2 = 75). The median rate of delayed graft function was 65.1% for uDCD and 52.0% for cDCD. The median 1-y graft survival for uDCD was 82.7% compared with 87.5% for cDCD (RR, 1.43; 95% confidence intervals, 1.02-2.01; P = 0.04; I 2 = 71%). The median 5-y graft survival for uDCD and cDCD was 70% each. Notably, the use of normothermic regional perfusion improved primary nonfunction rates in uDCD grafts.
Conclusions:
Although uDCD outcomes may be inferior in the short-term, the long-term outcomes are comparable to cDCD.
