Lessons Learned from a Single Center's Experience with 134 Donation after Cardiac Death Donor Kidney Transplants - 10/08/11

Doi : 10.1016/j.jamcollsurg.2010.12.033

Alan C. Farney, MD, PhD ^a,^⁎ , Michael H. Hines, MD, FACS ^b, Samer al-Geizawi, MD ^a, Jeffrey Rogers, MD, FACS ^a, Robert J. Stratta, MD, FACS ^a
^a Department of General Surgery, Wake Forest University School of Medicine, Winston-Salem, NC
^b Department of Cardiothoracic Surgery, Wake Forest University School of Medicine, Winston-Salem, NC

Address correspondence to: Alan C. Farney, MD, PhD, Department of General Surgery, Wake Forest University School of Medicine, Medical Center Blvd., Winston-Salem, NC 27157–1095

Résumé

Background

Reports of kidney transplantation from donation after cardiac death (DCD) donors describe high rates of delayed graft function (DGF).

Study Design

From April 1, 2003 to October 17, 2010, we performed 134 kidney transplants from DCD donors including 120 (90%) from standard-criteria donors (SCDs) and 14 (10%) from expanded-criteria donors (ECDs). Nineteen kidneys were recovered from donors managed with extracorporeal interval support for organ retrieval (EISOR) after cardiac arrest to minimize ischemic injury.

Results

Comparison of donor and recipient characteristics found no differences for cases managed with or without EISOR. Overall actuarial patient survival rates were 93%, 91%, and 89% at 1, 3, and 5 years, respectively, with a mean follow-up of 31 months. Overall actuarial kidney graft survival rates were 89%, 76%, and 76% at 1, 3, and 5 years, respectively. Actuarial graft survival rates of DCD ECD kidneys were 58% and 48% at 1 and 3 years, compared with 90% and 79% at 1 and 3 years for non-ECD grafts (p = 0.013). DGF occurred in 73 patients (54%) overall and was reduced from 55% to 21% (p = 0.016) with the use of EISOR in locally recovered kidneys. The mean resistance value on machine perfusion and the mean estimated glomerular filtration rate 1 month after transplantation were both improved (p < 0.05) in kidneys from donors managed with EISOR. Mean initial hospital stay was reduced from 8.0 to 5.0 days in patients receiving kidneys recovered with EISOR (p = 0.04).

Conclusions

EISOR is associated with a lower rate of DGF, lower graft resistance on machine perfusion, and shorter initial hospitalization. Kidneys from DCD SCDs have excellent medium-term outcomes and represent an important means of expanding the donor pool. Kidneys from DCD ECDs have inferior outcomes.

Le texte complet de cet article est disponible en PDF.

Abbreviations and Acronyms : BMI, CIT, CMV, DCD, DGF, ECD, EISOR, MDRD, SCD, UNOS, WIT