Kidney Transplantation from Donors after Cardiac Death: Uncontrolled versus Controlled Donation

• Published in: American journal of transplantation Vol. 11; no. 7; pp. 1427 - 1434
• Main Authors: Hoogland, E. R. P., Snoeijs, M.G.J., Winkens, B., Christaans, M. H. L., van Heurn, L. W. E.
• Format: Journal Article
• Language: English
• Published: Malden, USA Blackwell Publishing Inc 01.07.2011; Wiley
• Subjects: Adult; Biological and medical sciences; Death; Donation after cardiac death; Female; Graft Survival; Humans; kidney transplantation; Kidney Transplantation - mortality; Male; Medical sciences; Middle Aged; Netherlands; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; Tissue and Organ Procurement - methods; Tissue Donors; Treatment Outcome; uncontrolled and controlled donation; Warm Ischemia - adverse effects; Netherlands; Heart; Suboptimal donor; Human; Mortality; Donation after cardiac death; Homotransplantation; Kidney; Treatment; Urinary system; Surgery; Donation; Graft; Death; Circulatory system; Comparative study; uncontrolled and controlled donation; Kidney transplantation
• ISSN: 1600-6135; 1600-6143
• DOI: 10.1111/j.1600-6143.2011.03562.x

Kidney donation after cardiac death has been popularized over the last decade. The majority of these kidneys are from controlled donors. The number of organs for transplantation can be further increased by uncontrolled donors after cardiac death. The outcome of uncontrolled compared to controlled donor kidney transplantation is relatively unknown. We compared the long‐term outcome of kidney transplantation from uncontrolled (n = 128) and controlled (n = 208) donor kidneys procured in the Maastricht region from January 1, 1981 until January 1, 2008, and transplanted in the Eurotransplant region. The incidence of primary nonfunction and delayed graft function in both uncontrolled and controlled donor kidneys is relatively high (22% vs. 21%, and 61% vs. 56%, p = 0.43, respectively). Ten‐year graft and recipient survival are similar in both groups (50% vs. 46%, p = 0.74 and 61% vs. 60%, p = 0.76, respectively). Estimated glomerular filtration rates 1 year after transplantation are 40 ± 16 versus 42 ± 19 mL/min/1.73 m2, p = 0.55, with a yearly decline thereafter of 0.67 ± 3 versus 0.70 ± 7 mL/min/1.73 m2/year, p = 0.97. The outcome of kidney transplantation from uncontrolled and controlled donors after cardiac death is equivalent. This justifies the expansion of the donor pool with uncontrolled donors to reduce the still growing waiting list for renal transplantation, and may stimulate the implementation of uncontrolled kidney donation programs. This study shows that the short‐term and long‐term outcomes of kidney transplantation from uncontrolled and controlled donors after cardiac death are equivalent.