Optimal donation of kidney transplants after controlled circulatory death |
| |
| Authors: | Emilie Savoye Camille Legeai Julien Branchereau Samuel Gay Bruno Riou Francois Gaudez Benoit Veber Franck Bruyere Gaelle Cheisson Thomas Kerforne Lionel Badet Olivier Bastien Corinne Antoine and the cDCD National Steering Committee |
| |
| Institution: | 1. Agence de la biomédecine, Direction Prélèvement Greffe Organes-Tissus, Saint-Denis La Plaine, France;2. Department of Urology, Nantes University Hospital, University of Nantes, Nantes, France;3. Intensive Care Unit, Centre Hospitalier Annecy-genevois, Annecy, France;4. Sorbonne Université, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France;5. Department of Urology, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France;6. Department of Anesthesiology and Critical Care, Rouen University Hospital, Rouen, France;7. CHU Bretonneau, Tours, France;8. Department of Surgical Anesthesia and Intensive Care, South Paris University hospital, Hôpital de Bicêtre, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France;9. Anesthesia and Intensive Care Unit, Centre Hospitalier Universitaire de Poitiers, Poitiers, France;10. Groupement Hospitalier Edouard Herriot, Service d'urologie chirurgie de la Transplantation, Lyon, France |
| |
| Abstract: | Controlled donation after circulatory death (cDCD) is used for “extended criteria” donors with poorer kidney transplant outcomes. The French cDCD program started in 2015 and is characterized by normothermic regional perfusion, hypothermic machine perfusion, and short cold ischemia time. We compared the outcomes of kidney transplantation from cDCD and brain-dead (DBD) donors, matching cDCD and DBD kidney transplants by propensity scoring for donor and recipient characteristics. The matching process retained 442 of 499 cDCD and 809 of 6185 DBD transplantations. The DGF rate was 20% in cDCD recipients compared with 28% in DBD recipients (adjusted relative risk aRR], 1.43; 95% confidence interval CI] 1.12–1.82). When DBD transplants were ranked by cold ischemia time and machine perfusion use and compared with cDCD transplants, the aRR of DGF was higher for DBD transplants without machine perfusion, regardless of the cold ischemia time (aRR with cold ischemia time <18 h, 1.57; 95% CI 1.20–2.03, vs aRR with cold ischemia time ≥18 h, 1.79; 95% CI 1.31–2.44). The 1-year graft survival rate was similar in both groups. Early outcome was better for kidney transplants from cDCD than from matched DBD transplants with this French protocol. |
| |
| Keywords: | donors and donation: donation after circulatory death (DCD) health services and outcomes research ischemia reperfusion injury (IRI) kidney transplantation/nephrology organ procurement and allocation |
|
|
