Long-term renal function in kidneys from non-heart-beating donors: A single-center experience1

Gok, Muhammed A.; Buckley, P.; Shenton, B. K.; Balupuri, S.; El-Sheikh, Mohammed A F; Robertson, Helen Lee; Soomro, Naeem; Jaques, Bryon; Manas, Derek; Talbot, David

doi:10.1097/00007890-200209150-00013

Cited by 72 publications

(48 citation statements)

References 18 publications

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“…This contrasts with other studies which have shown a negative impact of DGF on kidney allograft survival from SCD donors (11)(12)(13)(14)(15)(16). DGF is a multifactorial phenomena resulting from warm and cold ischemia, poor donor quality and/or early rejection (16).…”

Section: Discussioncontrasting

confidence: 94%

Outcome of Kidney Transplantation Using Expanded Criteria Donors and Donation After Cardiac Death Kidneys: Realities and Costs

Saidi

Elias

Kawai

et al. 2007

American Journal of Transplantation

172

129

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Expanded criteria donors (ECDs) and donation after cardiac death (DCD) provide more kidneys in the donor pool. However, the financial impact and the long-term benefits of these kidneys have been questioned. From 1998 to 2005, we performed 271 deceased donor kidney transplants into adult recipients. There were 163 (60.1%) SCDs, 44 (16.2%) ECDs, 53 (19.6%) DCDs and 11 (4.1%) ECD/DCDs. The mean follow-up was 50 months. ECD and DCD kidneys had a significantly higher incidence of delayed graft function, longer time to reach serum creatinine below 3 (mg/dL), longer length of stay and more readmissions compared to SCDs. The hospital charge was also higher for ECD, ECD/DCD and DCD kidneys compared to SCDs, primarily due to the longer length of stay and increased requirement for dialysis ($70 030, $72 438, $72 789 and $47 462, respectively, p < 0.001). Early graft survival rates were comparable among all groups. However, after a mean follow-up of 50 months, graft survival was significantly less in the ECD group compared to other groups. Although our observations support the utilization of ECD and DCD kidneys, these transplants are associated with increased costs and resource utilization. Revised reimbursement guidelines will be required for centers that utilize these organs.

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Section: Discussioncontrasting

confidence: 94%

Outcome of Kidney Transplantation Using Expanded Criteria Donors and Donation After Cardiac Death Kidneys: Realities and Costs

Saidi

Elias

Kawai

et al. 2007

American Journal of Transplantation

172

129

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“…21 Liberal use of DCD kidneys may lead to considerable expansion of the donor pool but is associated with a relatively high incidence of delayed graft function and primary nonfunction. [12][13][14][15][16][17][18]22,23 In this study, graft failure in the first 3 months after transplantation was twice as likely for DCD kidneys than for CLINICAL EPIDEMIOLOGY www.jasn.org DBD kidneys; however, DCD kidneys that overcome the early posttransplantation period function as long as DBD kidneys [12][13][14][15][16][17][18] ; therefore, it is unclear whether dialysis patients who are on the waiting list should accept an offer for DCD kidney transplantation or continue dialysis treatment until a conventional DBD kidney is available.…”

Section: Discussionmentioning

confidence: 80%

“…As a consequence, the incidence of delayed graft function and primary nonfunction in DCD kidney transplantation is relatively high, although survival of functioning grafts seems to be satisfactory. [12][13][14][15][16][17][18] During the past decade, DCD has evolved into routine clinical practice that currently supplies Ͼ10% of all deceased-donor kidneys in the United States and up to 50% in the Netherlands; however, it is unknown whether patients who receive a DCD kidney live longer than patients who receive conventional therapy (i.e., continue dialysis treatment with the option of later receiving a DBD kidney). We therefore evaluated the effect of kidney transplantation from different types of deceased donors on the survival of dialysis patients who were on the waiting list in an observational cohort study including all patients who were registered on the Dutch waiting list for a first kidney transplantation between 1999 and 2004.…”

mentioning

confidence: 99%

Kidneys from Donors after Cardiac Death Provide Survival Benefit

Snoeijs¹,

Schaubel

Hené

et al. 2010

Journal of the American Society of Nephrology

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The continuing shortage of kidneys for transplantation requires major efforts to expand the donor pool. Donation after cardiac death (DCD) increases the number of available kidneys, but it is unknown whether patients who receive a DCD kidney live longer than patients who remain on dialysis and wait for a conventional kidney from a brain-dead donor (DBD). This observational cohort study included all 2575 patients who were registered on the Dutch waiting list for a first kidney transplant between January 1, 1999, and December 31, 2004. From listing until the earliest of death, living-donor kidney transplantation, or December 31, 2005, 459 patients received a DCD transplant and 680 patients received a DBD transplant. Graft failure during the first 3 months after transplantation was twice as likely for DCD kidneys than DBD kidneys (12 versus 6.3%; P ϭ 0.001). Standard-criteria DCD transplantation associated with a 56% reduced risk for mortality (hazard ratio 0.44; 95% confidence interval 0.24 to 0.80) compared with continuing on dialysis and awaiting a standard-criteria DBD kidney. This reduction in mortality translates into 2.4-month additional expected lifetime during the first 4 years after transplantation for recipients of DCD kidneys compared with patients who await a DBD kidney. In summary, standard-criteria DCD kidney transplantation associates with increased survival of patients who have ESRD and are on the transplant waiting list.

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“…However, the value of machine perfusion parameters to predict PNF is relatively unknown, as the incidence of PNF after transplantation is generally low. DGF, as an alternative outcome measure, is less useful because DGF does not affect long-term survival in DCD kidneys (4)(5)(6)(11)(12)(13)(14).…”

Section: Introductionmentioning

confidence: 99%

Renovascular Resistance of Machine-Perfused DCD Kidneys Is Associated with Primary Nonfunction

Vries

Hoogland

Winkens

et al. 2011

American Journal of Transplantation

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Donation after cardiac death (DCD) has shown to be a valuable extension of the donor pool despite a higher percentage of primary nonfunction (PNF). Limiting the incidence of PNF is of vital importance. Renovascular resistance is believed to predict graft outcome; however the literature is inconsistent. Therefore, we studied whether renovascular resistance is associated with PNF and whether this parameter should be used to discard donor kidneys. All transplanted DCD kidneys preserved by machine perfusion at our center between 1993 and 2007 were analyzed (n = 440). The effects of renovascular resistance on PNF, delayed graft function (DGF), and graft and patient survival were examined using multivariable analyses; predictive quality by calculating the area under the curve (AUC). We showed that renovascular resistance at the start of machine perfusion was significantly and independently associated with PNF (OR 2.040, 95% CI 1.362-3.056; p = 0.001), and DGF (OR 2.345, 95% CI 1.110-4.955; p = 0.025). Predictive quality was moderate (0.609, 95% CI 0.538-0.681). Graft and patient survival were not associated with renovascular resistance. We conclude that renovascular resistance in DCD kidneys is an independent risk factor for PNF; however, the predictive value is relatively low.

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Long-term renal function in kidneys from non-heart-beating donors: A single-center experience1

Cited by 72 publications

References 18 publications

Outcome of Kidney Transplantation Using Expanded Criteria Donors and Donation After Cardiac Death Kidneys: Realities and Costs

Outcome of Kidney Transplantation Using Expanded Criteria Donors and Donation After Cardiac Death Kidneys: Realities and Costs

Kidneys from Donors after Cardiac Death Provide Survival Benefit

Renovascular Resistance of Machine-Perfused DCD Kidneys Is Associated with Primary Nonfunction

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