Outcome of Kidney Transplantation From Nonheart-Beating Versus Heart-Beating Cadaveric Donors

Kokkinos, Constantinos; Antcliffe, David; Nanidis, Theodore; Darzi, Ara; Tekkis, Paris; Papalois, Vassilios

doi:10.1097/01.tp.0000261710.53848.51

Cited by 72 publications

(61 citation statements)

References 24 publications

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“…The DCD grafts in this study by all accounts appeared to have been of high quality, predominantly having short warm ischemia time and coming from younger donors. This finding was unexpected because late graft loss in DCD kidney transplants has not been described in adult recipients (5)(6)(7)(8)(9)(10)(11)(12), nor was it identified in a previous analysis of pediatric recipients (15). Our ability to detect this difference is likely due to a substantial increase in power (from 26 DCD recipients in the previously largest study to 137 DCD recipients in this study) and follow-up time.…”

Section: Discussionmentioning

confidence: 53%

“…In adults, DCD kidneys seem to result in similar graft and patient survival compared with donation after brain death (DBD) kidneys (5)(6)(7)(8)(9)(10)(11)(12). However, DCD kidneys also have a significantly higher rate of delayed graft function (DGF) compared with DBD kidneys (5,(7)(8)(9)(10)(11)(12).…”

Section: Introductionmentioning

confidence: 96%

“…However, DCD kidneys also have a significantly higher rate of delayed graft function (DGF) compared with DBD kidneys (5,(7)(8)(9)(10)(11)(12). DCD kidneys from younger donors and those with shorter cold ischemia time have the best outcomes in adult recipients (6,7,13).…”

Section: Introductionmentioning

confidence: 99%

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Late Graft Loss among Pediatric Recipients of DCD Kidneys

Arendonk

James

Locke

et al. 2011

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Kidney transplantation from donors after cardiac death (DCD) provides similar graft survival to donors after brain death (DBD) in adult recipients. However, outcomes of DCD kidneys in pediatric recipients remain unclear, primarily because of limited sample sizes.Design, setting, participants, & measurements We identified 137 pediatric (Ͻ18 years old) recipients of DCD kidneys between 1994 and 2010 using Scientific Registry of Transplant Recipients data and compared outcomes with 6059 pediatric recipients of DBD kidneys during the same time period, accounting for donor, recipient, and transplant characteristics using time-varying Cox regression and matched controls. Long-term follow-up (4 years or beyond) was available for 31 DCD recipients.Results Pediatric recipients of DCD kidneys experienced a significantly higher rate of delayed graft function (22.0% versus 12.3%; P ϭ 0.001), although lower than reported delayed graft function rates of DCD grafts in adults. Although DCD and DBD graft survival was equal in the early postoperative period, graft loss among pediatric recipients of DCD kidneys exceeded their DBD counterparts starting 4 years after transplantation. This effect was statistically significant in a multivariate Cox model (hazard ratio ϭ 2.03; 95% confidence interval, 1.21 to 3.39; P ϭ 0.007) and matched-controls analysis (hazard ratio ϭ 2.36; 95% confidence interval, 1.11 to 5.03; P ϭ 0.03).Conclusions A significant increase in DCD graft loss starting 4 years after transplantation motivates a cautious approach to the use of DCD kidneys in children, in whom long-term graft survival is of utmost importance.

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Section: Discussionmentioning

confidence: 53%

Section: Introductionmentioning

confidence: 96%

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Late Graft Loss among Pediatric Recipients of DCD Kidneys

Arendonk

James

Locke

et al. 2011

Clinical Journal of the American Society of Nephrology

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“…DCD grafts, however, are exposed to significantly more ischemia-reperfusion injury than organs derived from donation after brain death. Previous studies have reported a threefold to fourfold higher risk of delayed graft function (DGF) with DCD kidneys as compared to kidneys from donation after brain death donors (DBD) (1,2). Primary nonfunction also occurred more frequently.…”

Section: Introductionmentioning

confidence: 99%

“…Primary nonfunction also occurred more frequently. Initial graft survival of DCD kidneys is generally inferior, but becomes comparable to DBD grafts at 5 years and 10 years after transplantation (2,3). The most obvious approach to minimize ischemia-reperfusion injury would be to keep warm ischemia time as short as possible and to limit cold ischemic time.…”

Section: Introductionmentioning

confidence: 99%