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Kidney transplant from uncontrolled donation after circulatory death donors maintained by nECMO has long‐term outcomes comparable to standard criteria donation after brain death
Authors:Marí  a Molina,F  lix Guerrero‐Ramos,Mario Fern  ndez‐Ruiz,Esther Gonz  lez,Jimena Cabrera,Enrique Morales,Eduardo Gutierrez,Eduardo Hern  ndez,Natalia Polanco,Ana Hern  ndez,Manuel Praga,Alfredo Rodriguez‐Antolí  n,Manuel Pamplona,Federico de la Rosa,Teresa Cavero,Mario Chico,Alicia Villar,Iago Justo,Amado Andr  s
Affiliation:María Molina,Félix Guerrero‐Ramos,Mario Fernández‐Ruiz,Esther González,Jimena Cabrera,Enrique Morales,Eduardo Gutierrez,Eduardo Hernández,Natalia Polanco,Ana Hernández,Manuel Praga,Alfredo Rodriguez‐Antolín,Manuel Pamplona,Federico de la Rosa,Teresa Cavero,Mario Chico,Alicia Villar,Iago Justo,Amado Andrés
Abstract:Uncontrolled donation after circulatory death (uDCD) increases organ availability for kidney transplant (KT) with short‐term outcomes similar to those obtained from donation after brain death (DBD) donors. However, heterogeneous results in the long term have been reported. We compared 10‐year outcomes between 237 KT recipients from uDCD donors maintained by normothermic extracorporeal membrane oxygenation (nECMO) and 237 patients undergoing KT from standard criteria DBD donors during the same period at our institution. We further analyzed risk factors for death‐censored graft survival in the uDCD group. Delayed graft function (DGF) was more common in the uDCD group (73.4% vs 46.4%; P < .01), although glomerular filtration rates at the end of follow‐up were similar in the 2 groups. uDCD and DBD groups had similar rates for 10‐year death‐censored graft (82.1% vs 80.4%; P = .623) and recipient survival (86.2% vs 87.6%; P = .454). Donor age >50 years was associated with graft loss in the uDCD group (hazard ratio: 1.91; P = .058), whereas the occurrence of DGF showed no significant effect. uDCD KT under nECMO support resulted in similar graft function and long‐term outcomes compared with KT from standard criteria DBD donors. Increased donor age could negatively affect graft survival after uDCD donation.
Keywords:clinical research / practice  donors and donation: donation after brain death (DBD)  donors and donation: donation after circulatory death (DCD)  extracorporeal membrane oxygenation (ECMO)  graft survival  kidney disease  kidney transplantation / nephrology
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