Expanding the Donor Kidney Pool: Utility of Renal Allografts Procured in a Setting of Uncontrolled Cardiac Death

• Published in: American journal of transplantation Vol. 6; no. 7; pp. 1682 - 1688
• Main Authors: Gagandeep, S., Matsuoka, L., Mateo, R., Cho, Y. W., Genyk, Y., Sher, L., Cicciarelli, J., Aswad, S., Jabbour, N., Selby, R.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.07.2006; Blackwell
• Subjects: Adult; Age Distribution; Biological and medical sciences; Brain Death; Cardiac death; Death; Female; Graft Survival; Humans; kidney donor; Kidney Transplantation; Male; Medical sciences; Middle Aged; Risk Factors; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; Time Factors; Tissue and Organ Procurement - statistics & numerical data; Tissue Donors - classification; Tissue Donors - statistics & numerical data; Transplantation, Homologous; uncontrolled outcomes; Heart; Human; Prognosis; Mortality; uncontrolled outcomes; Homotransplantation; Kidney; Treatment; Urinary system; Donor; Cardiac death; Surgery; Graft; Evolution; Death; Pool; Circulatory system; kidney donor; Kidney transplantation
• ISSN: 1600-6135; 1600-6143
• DOI: 10.1111/j.1600-6143.2006.01386.x

The chronic shortage of deceased kidney donors has led to increased utilization of donation after cardiac death (DCD) kidneys, the majority of which are procured in a controlled setting. The objective of this study is to evaluate transplantation outcomes from uncontrolled DCD (uDCD) donors and evaluate their utility as a source of donor kidneys. From January 1995 to December 2004, 75 865 kidney‐alone transplants from donation after brain death (DBD) donors and 2136 transplants from DCD donors were reported to the United Network for Organ Sharing. Among the DCD transplants, 1814 were from controlled and 216 from uncontrolled DCD donors. The log‐rank test was used to compare survival curves. The incidence of delayed graft function in controlled DCD (cDCD) was 42% and in uDCD kidneys was 51%, compared to only 24% in kidneys from DBD donors (p < 0.001). The overall graft and patient survival of DCD donors was similar to that of DBD donor kidneys (p = 0.66; p = 0.88). Despite longer donor warm and cold ischemic times, overall graft and patient survival of uDCD donors was comparable to that of cDCD donors (p = 0.65, p = 0.99). Concerted efforts should be focused on procurement of uDCD donors, which can provide another source of quality deceased donor kidneys. In kidney transplants obtained by donation after cardiac death, reported to UNOS, the kidneys from uncontrolled DBD donors showed longer ischemic times but similar delayed graft function and survival rates to the kidneys from controlled DCD donors, confirming that this source of kidneys is suitable. See also editorial by Sung and Punch in this issue on page 1505.