Lessons Learned from a Single Center’s Experience with 134 Donation after Cardiac Death Donor Kidney Transplants

Farney, Alan C.; Hines, Michael H.; Al-Geizawi, S.; Rogers, Jeffrey; Stratta, Robert J.

doi:10.1016/j.jamcollsurg.2010.12.033

Cited by 62 publications

(79 citation statements)

References 41 publications

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“…The use of extracorporeal interval support in locally recovered kidneys reduced the incidence of DGF from 55% to 21% (P = 0.016) [40] .…”

Section: Extracorporeal Supportmentioning

confidence: 98%

“…To minimize ischemic injury, Farney et al [40] utilised extracorporeal interval support for organ retrieval after cardiac arrest and reported an overall actuarial kidney graft survival rates of 89%, 76% and 76% at 1, 3 and 5 years, respectively. The use of extracorporeal interval support in locally recovered kidneys reduced the incidence of DGF from 55% to 21% (P = 0.016) [40] .…”

Section: Extracorporeal Supportmentioning

confidence: 99%

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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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“…The use of extracorporeal interval support in locally recovered kidneys reduced the incidence of DGF from 55% to 21% (P = 0.016) [40] .…”

Section: Extracorporeal Supportmentioning

confidence: 98%

Section: Extracorporeal Supportmentioning

confidence: 99%

Kidney donation after cardiac death

Akoh¹

2012

WJN

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“…7 Absolute contraindications for use of DCD kidneys included initial donor estimated creatinine clearance < 1 mL/s (using the Cockcroft-Gault formula), malignancy, human immunodeficiency virus serology; warm ischemia time > 90 minutes in an non-ECD and > 60 minutes in an ECD, machine perfusion flow ≤ 1 mL/S or resistance > 0.4 mm Hg/mL/min, and biopsy findings such as > 15% glomerulosclerosis or a Remuzzi sum score ≥ 7. 8…”

Section: Donor Selectionmentioning

confidence: 99%

Untitled

Yuan

Han

Wang

et al. 2014

Exp Clin Transplant

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where we hosted one of the largest donation after cardiac death organ transplant programs in the country. We report our initial single-center experiences of kidney transplant from donation after cardiac deaths. Materials and Methods: From January 2011 to July 2013 at our center, 101 kidney transplants from donation after cardiac death donors were performed. The results of kidney transplants from donation after cardiac death donors were compared with those of 50 kidney transplants from donation after brain death performed during the same time. Results: Delayed graft function occurred more frequently in donation after cardiac death than donation after brain death kidneys (16.8% vs 4.0%; P = .035). There was no difference in the incidence of acute rejection between donation after cardiac death and donation after brain death kidneys (10.9% vs 6.0%). Actual 1-year graft survival rate was similar (donation after cardiac death 94.4% vs donation after brain death 96.2%). Estimated glomerular filtration rate at 12 months was similar between donation after cardiac death and donation after brain death kidneys (73.8 ± 20.0 vs 77.8 ± 22.7 mL/min/1.73m 2 ). Conclusions: Kidney transplants from donation after cardiac death donors have comparable short-term outcomes to kidney transplants from donation after brain death donors. Donation after cardiac death can play a crucial role in overcoming the organ shortage in China.

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“…All but 5 pancreas transplants have been obtained from brain-dead donors. Five SKPTs were performed from donation after cardiac death donors at our hospital in which extracorporeal support was used to assist in management of the donor after declaration of death by cardiocirculatory arrest [1,2].…”

Section: ■ Abstractmentioning

confidence: 99%

Pancreas Transplantation: Lessons Learned From a Decade of Experience at Wake Forest Baptist Medical Center

et al. 2011

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■ AbstractThis article reviews the outcome of pancreas transplantations in diabetic recipients according to risk factors, surgical techniques, and immunosuppression management that evolved over the course of a decade at Wake Forest Baptist Medical Center. A randomized trial of alemtuzumab versus rabbit anti-thymocyte globulin (rATG) induction in simultaneous kidney-pancreas transplantation (SKPT) at our institution demonstrated lower rates of acute rejection and infection in the alemtuzumab group. Consequently, alemtuzumab induction has been used exclusively in all pancreas transplantations since February 2009. Early steroid elimination has been feasible in the majority of patients. Extensive experience with surveillance pancreas biopsies in solitary pancreas transplantation (SPT) is described. Surveillance pancreas biopsy-directed immunosuppression has contributed to equivalent long-term pancreas graft survival rates in SKPT and SPT recipients at our center, in contrast to recent registry reports of persistently higher rates of immunologic pancreas graft loss in SPT. Furthermore, the impact of donor and recipient selection on outcomes is explored. Excellent results have been achieved with older (extended) donors and recipients, in recipients of organs from donation after cardiac death donors managed with extracorporeal support, and in African-American patients. Type 2 diabetics with detectable C-peptide levels have been transplanted successfully with outcomes comparable to those of insulinopenic diabetics. Our experiences are discussed in the light of findings reported in the literature.

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Lessons Learned from a Single Center’s Experience with 134 Donation after Cardiac Death Donor Kidney Transplants

Cited by 62 publications

References 41 publications

Kidney donation after cardiac death

Kidney donation after cardiac death

Untitled

Pancreas Transplantation: Lessons Learned From a Decade of Experience at Wake Forest Baptist Medical Center

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