Uncontrolled donors with controlled reperfusion after sixty minutes of asystole: a novel reliable resource for kidney transplantation

• Published in: PloS one Vol. 8; no. 5; p. e64209
• Main Authors: Reznik, Oleg N, Skvortsov, Andrei E, Reznik, Alexander O, Ananyev, Alexey N, Tutin, Alexey P, Kuzmin, Denis O, Bagnenko, Sergey F
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 30.05.2013; Public Library of Science (PLoS)
• Subjects: Adult; Blood & organ donations; Brain; Business travel; Cardiopulmonary resuscitation; Cold; CPR; Creatinine; Creatinine - blood; Death, Sudden, Cardiac; Donors; Ethics; Female; Follow-Up Studies; Graft rejection; Grafting; Grafts; Heart; Heart diseases; Heart surgery; Humans; Intubation; Ischemia; Kaplan-Meier Estimate; Kidney transplantation; Kidney Transplantation - methods; Kidney transplants; Kidneys; Leukocytes; Lungs; Male; Medicine; Middle Aged; Organ donors; Perfusion; Postoperative Period; Rejection rate; Reperfusion; Resuscitation; Social and Behavioral Sciences; Survival; Time Factors; Tissue Donors; Transplantation; Transplants & implants; Russia
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0064209

Organ shortage leads to usage of kidneys from donors after sudden cardiac death, or uncontrolled donors (UDCD). Ischemic injury due to cessation of circulation remains a crucial problem that limits adoption of UDCD. Our clinical investigation was to determine the applicability of kidneys obtained from UDCD and resuscitated by extracorporeal perfusion in situ after 60 minutes of asystole. In 2009-2011, organ procurement service of St. Petersburg, obtained kidneys from 22 UDCD with critically expanded warm ischemic time (WIT). No patients were considered as potential organ donors initially. All donors died after sudden irreversible cardiac arrest. Mean WIT was 61.4±4.5 minutes. For kidney resuscitation, the subnormothermic extracorporeal abdominal perfusion with thrombolytics and leukocyte depletion was employed. Grafts were transplanted into 44 recipients. The outcomes of transplantation of resuscitated kidneys were compared to outcomes of 87 KTx from 74 brain death donors (BDDs). Immediate functioning of kidney grafts was observed in 21 of the 44 recipients, with no cases of primary non function. By the end of the first post-transplant year there was an acute rejection rate of 9.1% (4 episodes of rejection) in the UDCD group versus 14.2% (13 episodes of rejection) in the BDD group. The actual 1-year graft survival rate was 95.5% (n = 42) in UDCD group, and 94.6% (n = 87) in BDD group. Creatinine levels at the end of the first year were 0.116±0.008 and 0.115±0.004 mmol/l in UDCD and BDD groups, respectively. UDCD kidneys with critically expanded WIT could be succefully used for transplantation if in situ organ "resuscitation" perfusion is included into procurement protocol. The results of 1-year follow-up meet the generally accepted criteria for graft survival and function. In situ reperfusion may exert a therapeutic effect on grafts before procurement. This approach could substantially expand the organ donors' pool.