Improved Outcomes of Renal Transplantation from Cardiac Death Donors: A 30-Year Single Center Experience

Tojimbara, Tamotsu; Fuchinoue, Shohei; Iwadoh, Kazuhiro; Koyama, Ichiro; Sannomiya, Akihito; Kato, Yojiro; Nanmoku, Koji; Kai, Kotaro; Nakajima, Ichiro; Toma, Hiroshi; Teraoka, Satoshi

doi:10.1111/j.1600-6143.2007.01664.x

Cited by 56 publications

(41 citation statements)

References 22 publications

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“…In this study, there was no difference in overall graft survival of ECD/DCD versus non-ECD/DCD. Additionally, when comparing those with DGF versus immediate graft function, there was no significant difference in the proportion of ECD kidneys with DGF (15). However, other studies have shown inferior graft survival in recipients of ECD/DCD kidneys when compared to non-ECD/DCD kidneys (16,17).…”

Section: Discussionmentioning

confidence: 82%

Does Expanded Criteria Donor Status Modify the Outcomes of Kidney Transplantation From Donors After Cardiac Death?

Singh

Kim

2013

American Journal of Transplantation

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The outcomes of kidney transplants that simultaneously exhibit donation after cardiac death (DCD) and expanded criteria donor (ECD) characteristics have not been well studied. We examined the outcomes of DCD versus non-DCD kidney transplants as a function of ECD status and the kidney donor risk index (KDRI interaction = 0.14).Moreover, the hazard ratios did not significantly vary by KDRI quintiles (p = 0.40). Similar trends were seen for death-censored graft failure and death with graft function. In conclusion, ECD status or higher KDRI score did not appreciably increase the relative hazard of adverse graft and patient outcomes in DCD KTR. These findings suggest that the judicious use of ECD/DCD donor kidneys may be an appropriate strategy to expand the donor pool.

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Section: Discussionmentioning

confidence: 82%

Does Expanded Criteria Donor Status Modify the Outcomes of Kidney Transplantation From Donors After Cardiac Death?

Singh

Kim

2013

American Journal of Transplantation

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“…When compared with kidneys recovered from DBD, DCD kidneys have increased rates of DGF and primary non function (PNF) [15,27,30] -mainly due to increased warm ischaemia time during recovery but also due to cold ischaemia. Based on a porcine model of DCD, Jani et al [54] hypothesised that DCD kidneys have increased caspase-1 due to warm ischemia and increased caspase-3 and apoptosis due to cold ischaemia.…”

Section: Dgf and Primary Non Functionmentioning

confidence: 99%

“…Since its implementation four and a half years ago, DCD has accounted for 10.9% of deceased donor activity in Ontario, Canada [18] . The majority of DCD kidneys are from controlled donors meaning that the number of organs can be further increased by utilising uncontrolled donors [3,4,12,[19][20][21][22][23][24][25][26][27][28][29][30] although the associated workload is considerably more and the yield rate poorer. Reports from some centres show that DCD from deaths outside the hospital may be a good source of donor kidneys and may provide a way to successfully increase the donor pool for organ transplantation [31] .…”

Section: Spread Of Practicementioning

confidence: 99%

Kidney donation after cardiac death

Akoh¹

2012

WJN

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There is continuing disparity between demand for and supply of kidneys for transplantation. This review describes the current state of kidney donation after cardiac death (DCD) and provides recommendations for a way forward. The conversion rate for potential DCD donors varies from 40%-80%. Compared to controlled DCD, uncontrolled DCD is more labour intensive, has a lower conversion rate and a higher discard rate. The super-rapid laparotomy technique involving direct aortic cannulation is preferred over in situ perfusion in controlled DCD donation and is associated with lower kidney discard rates, shorter warm ischaemia times and higher graft survival rates. DCD kidneys showed a 5.73-fold increase in the incidence of delayed graft function (DGF) and a higher primary non function rate compared to donation after brain death kidneys, but the long term graft function is equivalent between the two. The cold ischaemia time is a controllable factor that significantly influences the outcome of allografts, for example, limiting it to < 12 h markedly reduces DGF. DCD kidneys from donors < 50 function like standard criteria kidneys and should be viewed as such. As the majority of DCD kidneys are from controlled donation, incorporation of uncontrolled donation will expand the donor pool. Efforts to maximise the supply of kidneys from DCD include: implementing organ recovery from emergency department setting; improving family consent rate; utilising technological developments to optimise organs either prior to recovery from donors or during storage; improving organ allocation to ensure best utility; and improving viability testing to reduce primary non function.

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“…[7][8][9] However, this vital source of organs continues to be underutilized. [10][11][12][13][14] Over the past decade, because of severe shortage of organs, the criteria for organ donation among trauma donors have been extended to include DCD as a potential source of organ donation. However, the true utilization of DCD in trauma patients remains unknown.…”

mentioning

confidence: 99%