Machine Perfusion Versus Cold Storage for the Preservation of Kidneys Donated After Cardiac Death

Jochmans, Ina; Moers, Cyril; Smits, Jacqueline M.; Leuvenink, Henri G. D.; Treckmann, Juergen; Paul, Andreas; Rahmel, Axel; Squifflet, Jean‐Paul; Heurn, Ernest van; Monbaliu, Diethard; Ploeg, Rutger J.; Pirenne, Jacques

doi:10.1097/sla.0b013e3181ffc256

Cited by 281 publications

(253 citation statements)

References 30 publications

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“…23 It also notably improves outcomes by decreasing the prevalence of delayed graft function. 24,25 Because prolonged cold ischemic time (up to 48 hours) is widely accepted, en bloc kidneys procured from donor newborns can be transported easily to specialized centers willing to transplant these small organs. Thus, implementation of NICU DCDD programs nationwide could feasibly provide donor kidneys for selected transplant centers even if local or regional programs elect not to transplant kidneys from infant donors.…”

Section: Discussionmentioning

confidence: 99%

Identifying Potential Kidney Donors Among Newborns Undergoing Circulatory Determination of Death

Hanley¹,

Kim

Willey

et al. 2014

Pediatrics

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BACKGROUND: Over 96 000 patients await kidney transplantation in the United States, and 35 000 more are wait-listed annually. The demand for donor kidneys far outweighs supply, resulting in significant waiting list morbidity and mortality. We sought to identify potential kidney donors among newborns because en bloc kidney transplantation donation after circulatory determination of death (DCDD) may broaden the donor pool. METHODS: We reviewed discharges from our 84-bed NICU between November 2002 and October 2012 and identified all deaths. The mode of death among potential organ donors (weight ≥1.8 kg) was recorded. Patients undergoing withdrawal of life support were further evaluated for DCDD potential. After excluding patients with medical contraindications, those with warm ischemic time (WIT) less than 120 minutes were characterized as potential kidney donors. RESULTS: There were 11 201 discharges. Of 609 deaths, 359 patients weighed ≥1.8 kg and 159 died after planned withdrawal of life support. The exact time of withdrawal could not be determined for 2 patients, and 100 had at least 1 exclusion criterion. Of the remaining patients, 42 to 57 infants were potential en bloc kidney donors depending on acceptance threshold for WIT. Applying a 40% to 70% consent rate range would yield 1.7 to 4 newborn DCDD donors per year. CONCLUSIONS: A neonatal DCDD kidney program at our institution could provide 2 to 4 paired kidneys for en bloc transplantation each year. Implementing a DCDD kidney donation program in NICUs could add a new source of donors and increase the number of kidneys available for transplantation.

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Section: Discussionmentioning

confidence: 99%

Identifying Potential Kidney Donors Among Newborns Undergoing Circulatory Determination of Death

Hanley¹,

Kim

Willey

et al. 2014

Pediatrics

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“…But 1-year graft and patient survival was similar in both groups. 14 In contrast to the aforesaid study, Watson and associates found that there was no difference in the incidence of DGF preserved by machine perfusion or cold storage in kidney transplants from DCD. 15 The presence of DGF is an early surrogate marker of organ quality and preservation.…”

Section: Discussionmentioning

confidence: 68%

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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“…In a sub-analysis of 82 pairs of DCD kidneys from the European trial, the DGF rate in the HMP group was 53.7% compared to 69.5% in kidneys that were statically stored [85]. However, there was no significant difference in graft survival at 1 or 3 years.…”

Section: Hypothermic Machine Perfusionmentioning

confidence: 99%

Cold Ischaemic Injury in Kidney Transplantation

Hosgood¹,

Hunter²,

Nicholson³

2012

Current Concepts in Kidney Transplantation

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Machine Perfusion Versus Cold Storage for the Preservation of Kidneys Donated After Cardiac Death

Abstract: Hypothermic machine perfusion was associated with a reduced risk of DGF and better early graft function up to 1 month after transplantation. Routine preservation of DCD kidneys by hypothermic machine perfusion is therefore advisable.

Cited by 281 publications

References 30 publications

Identifying Potential Kidney Donors Among Newborns Undergoing Circulatory Determination of Death

Identifying Potential Kidney Donors Among Newborns Undergoing Circulatory Determination of Death

Untitled

Cold Ischaemic Injury in Kidney Transplantation

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