Survival of Kidney Allograft of Donors after Circulatory Death Is Similar to Donors after Brain Death: Experience in a Regional Program

Gentil, M.A.; Castro, P.; Ballesteros, Luis Ernesto; Gracia-Guindo, María C.; Cabello, Mercedes; Mazuecos, María Auxiliadora; Rodríguez‐Benot, Alberto; González-Corvillo, C.; Borrego, J; Ortega, Antonio Osuna; Alonso, Manuel

doi:10.1016/j.transproceed.2015.09.045

Cited by 6 publications

(6 citation statements)

References 2 publications

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“…A less reticent attitude towards DCD grafts is supported by preliminary reports from small observational studies [12], [13], [14], [15], [16], and in particular by data from the UK registry [17], [19]. Although all reports indicate similar outcomes for DCD and DBD grafts, small sized studies are sensitive to publication bias [23], and small proportions of DCD procedures (less than 10% of the procedures) raise concerns on a potential selection bias with respect to superior donor characteristics of DCD grafts accepted for transplantation.…”

Section: Discussionmentioning

confidence: 97%

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Equivalent Long-term Transplantation Outcomes for Kidneys Donated After Brain Death and Cardiac Death: Conclusions From a Nationwide Evaluation

et al. 2018

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Background Despite growing waiting lists for renal transplants, hesitations persist with regard to the use of deceased after cardiac death (DCD) renal grafts. We evaluated the outcomes of DCD donations in The Netherlands, the country with the highest proportion of DCD procedures (42.9%) to test whether these hesitations are justified. Methods This study included all procedures with grafts donated after brain death (DBD) (n = 3611) and cardiac death (n = 2711) performed between 2000 and 2017. Transplant outcomes were compared by Kaplan Meier and Cox regression analysis, and factors associated with short (within 90 days of transplantation) and long-term graft loss evaluated in multi-variable analyses. Findings Despite higher incidences of early graft loss (+ 50%) and delayed graft function (+ 250%) in DCD grafts, 10-year graft and recipient survival were similar for the two graft types (Combined 10-year graft survival: 73.9% (95% CI: 72.5–75.2), combined recipient survival: 64.5% (95 CI: 63.0–66.0%)). Long-term outcome equivalence was explained by a reduced impact of delayed graft function on DCD graft survival (RR: 0.69 (95% CI: 0.55–0.87), p < 0.001). Mid and long-term graft function (eGFR), and the impact of incident delayed graft function on eGFR were similar for DBD and DCD grafts. Interpretation Mid and long term outcomes for DCD grafts are equivalent to DBD kidneys. Poorer short term outcomes are offset by a lesser impact of delayed graft function on DCD graft survival. This nation-wide evaluation does not justify the reluctance to use of DCD renal grafts. A strong focus on short-term outcome neglects the superior recovery potential of DCD grafts.

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Section: Discussionmentioning

confidence: 97%

“…Remarkably, some small cohort studies [12], [13], [14], [15], [16], and follow up data from the UK transplant registry do not support these reservations towards the use of DCD grafts [17]. In fact, the UK registry data indicate equal 5-year kidney graft survival rates for DCD grafts and grafts from donors donated after brain-death (DBD).…”

Section: Introductionmentioning

confidence: 99%

Equivalent Long-term Transplantation Outcomes for Kidneys Donated After Brain Death and Cardiac Death: Conclusions From a Nationwide Evaluation

et al. 2018

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“…The outcomes of graft and patient survival at 1 y are good but slightly lower in comparison to living donor kidneys. [8][9][10][11]18,20,21,[24][25][26][27][28][29][30][31][32][33]38 At 5 y, there is a marked reduction in graft and patient survival, in particular in ECD kidney transplants (Table 1). [8][9][10][11]18,20,21,[24][25][26][27][28][29][30][31][32][33]38 KIDNEY PRESERVATION TECHNIQUES…”

Section: Kidney Donors Live Donor Kidney Transplantationmentioning

confidence: 99%

“…The outcomes of graft and patient survival at 1 y are good but slightly lower in comparison to living donor kidneys. 8-11,18,20,21,24-33,38 At 5 y, there is a marked reduction in graft and patient survival, in particular in ECD kidney transplants (Table 1). 8-11,18,20,21,24-33,38…”

Section: Kidney Donorsmentioning

confidence: 99%

Advances in Kidney Preservation Techniques and Their Application in Clinical Practice

Hosgood

Brown²,

Nicholson³

2021

Transplantation

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The use of cold preservation solutions to rapidly flush and cool the kidney followed by static cold storage in ice has been the standard kidney preservation technique for the last 50 y. Nonetheless, changing donor demographics that include organs from extended criteria donors and donation after circulatory death donors have led to the adoption of more diverse techniques of preservation. Comparison of hypothermic machine perfusion and static cold storage techniques for deceased donor kidneys has long been debated and is still contested by some. The recent modification of hypothermic machine perfusion techniques with the addition of oxygen or perfusion at subnormothermic or near-normothermic temperatures are promising strategies that are emerging in clinical practice. In addition, the use of normothermic regional perfusion to resuscitate abdominal organs of donation after circulatory death donors in situ before cold flushing is also increasingly being utilized. This review provides a synopsis of the different types of preservation techniques including their mechanistic effects and the outcome of their application in clinical practice for different types of donor kidney.

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“…This runs in the face of recent data, which suggest that after 10 and 15 years of follow-up, there is no difference in graft or patient survival. [5][6][7] Deceased donor kidneys suffering AKI are also more likely to have an elevated KDPI and be discarded. 8 Yet these are viable organs, which can offer recipient benefit.…”

Section: Introductionmentioning

confidence: 99%

DCD Renal Transplantation From Donors With Acute Kidney Injury

et al. 2020

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Survival of Kidney Allograft of Donors after Circulatory Death Is Similar to Donors after Brain Death: Experience in a Regional Program

Cited by 6 publications

References 2 publications

Equivalent Long-term Transplantation Outcomes for Kidneys Donated After Brain Death and Cardiac Death: Conclusions From a Nationwide Evaluation

Equivalent Long-term Transplantation Outcomes for Kidneys Donated After Brain Death and Cardiac Death: Conclusions From a Nationwide Evaluation

Advances in Kidney Preservation Techniques and Their Application in Clinical Practice

DCD Renal Transplantation From Donors With Acute Kidney Injury

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