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Implementation of donation after circulatory death kidney transplantation can safely enlarge the donor pool: A systematic review and meta-analysis. Int J Surg 2021; 92:106021. [PMID: 34256169 DOI: 10.1016/j.ijsu.2021.106021] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 06/14/2021] [Accepted: 07/08/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Donation after circulatory death (DCD) kidney transplantation has been introduced to address organ shortage. However, DCD kidneys are not accepted worldwide due to concerns about inferior quality. To investigate whether these concerns are justified, we performed a systematic review and meta-analysis to investigate DCD graft outcomes compared to donation after brain death (DBD). MATERIALS AND METHODS EMBASE, Medline, Cochrane, Web of Science and Google Scholar were searched from database inception until September 2020. Exclusion criteria were studies reporting on pediatric/dual kidney transplants, multi-organ transplants or studies including normothermic perfusion techniques. The primary outcome was graft survival. Secondary outcomes were primary non-function (PNF), delayed graft function (DGF), 3-months biopsy-proven acute rejection (BPAR), 1-year estimated Glomerular Filtration Rate (eGFR), patient survival, and urologic complications. A random-effects model was used for meta-analysis. Meta-regression analysis was performed in case of high between-study heterogeneity. RESULTS Fifty-one studies were included, comprising 73,454 DCD and 518,229 DBD recipients. One-year graft loss was increased in DCD recipients (death-censored: risk ratio (RR) 1.10 (95%-confidence interval (CI) 1.04-1.16), all-cause: RR 1.13 (95%-CI 1.08-1.19)). Ten-year graft loss was similar to DBD (death-censored: RR 1.02 (95%-CI 0.92-1.13), all-cause: RR 1.03 (95%-CI 0.94-1.13)). DCD recipients had an increased risk of PNF (RR 1.43 (95%-CI 1.26-1.62)), DGF (RR 2.02 (95%-CI 1.88-2.16)), and 1-year mortality (RR 1.10 (95%-CI 1.01-1.21)). No differences were observed for 3-months BPAR, ureter stenosis/leakage, 1-year eGFR and 10-year mortality. CONCLUSION Long-term DCD kidney transplant outcomes are similar to DBD despite a higher risk of PNF, DGF, and a 13% increased risk of graft loss in the first year after transplantation. These results should encourage implementation of DCD programs.
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Sánchez-Fructuoso AI, Pérez-Flores I, Del Río F, Blázquez J, Calvo N, Moreno de la Higuera MÁ, Gómez A, Alonso-Lera S, Soria A, González M, Corral E, Mateos A, Moreno-Sierra J, Fernández Pérez C. Uncontrolled donation after circulatory death: A cohort study of data from a long-standing deceased-donor kidney transplantation program. Am J Transplant 2019; 19:1693-1707. [PMID: 30589507 DOI: 10.1111/ajt.15243] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 11/29/2018] [Accepted: 12/10/2018] [Indexed: 01/25/2023]
Abstract
Despite good long-term outcomes of kidney transplants from controlled donation after circulatory death (DCD) donors, there are few uncontrolled DCD (uDCD) programs. This longitudinal study compares outcomes for all uDCD (N = 774) and all donation after brain death (DBD) (N = 613) kidney transplants performed from 1996 to 2015 at our center. DBD transplants were divided into those from standard-criteria (SCD) (N = 366) and expanded-criteria (N = 247) brain-dead donors (ECD). One-, 5-, and 10-year graft survival rates were 91.7%, 85.7%, and 80.6% for SCD; 86.0%, 75.8%, and 61.4% for ECD; and 85.1%, 78.1%, and 72.2% for uDCD, respectively. Graft survival was worse in recipients of uDCD kidneys than of SCD (P = .004) but better than in transplants from ECD (P = .021). The main cause of graft loss in the uDCD transplants was primary nonfunction. Through logistic regression, donor death due to pulmonary embolism (OR 4.31, 95% CI 1.65-11.23), extrahospital CPR time ≥75 minutes (OR1.94, 95%CI 1.18-3.22), and in-hospital CPR time ≥50 minutes (OR 1.79, 95% CI 1.09-2.93) emerged as predictive factors of primary nonunction. According to the outcomes of our long-standing kidney transplantation program, uDCD could help expand the kidney donor pool.
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Affiliation(s)
| | - Isabel Pérez-Flores
- Nephrology Department, Hospital Clínico San Carlos, Universidad Complutense, Madrid, Spain
| | - Francisco Del Río
- Transplantation Coordination Unit, Hospital Clínico San Carlos, Universidad Complutense, Madrid, Spain
| | - Jesús Blázquez
- Urology Department, Hospital Clínico San Carlos, Universidad Complutense, Madrid, Spain
| | - Natividad Calvo
- Nephrology Department, Hospital Clínico San Carlos, Universidad Complutense, Madrid, Spain
| | | | - Angel Gómez
- Urology Department, Hospital Clínico San Carlos, Universidad Complutense, Madrid, Spain
| | - Santiago Alonso-Lera
- Surgery Department, Hospital Clínico San Carlos, Universidad Complutense, Madrid, Spain
| | - Ana Soria
- Transplantation Coordination Unit, Hospital Clínico San Carlos, Universidad Complutense, Madrid, Spain
| | - Manuel González
- Transplantation Coordination Unit, Hospital Clínico San Carlos, Universidad Complutense, Madrid, Spain
| | | | - Alonso Mateos
- SUMMA112, School of Medicine, Francisco de Vitoria University, Madrid, Spain
| | - Jesús Moreno-Sierra
- Transplantation Coordination Unit, Hospital Clínico San Carlos, Universidad Complutense, Madrid, Spain
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3
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Jochmans I, Darius T, Kuypers D, Monbaliu D, Goffin E, Mourad M, Ledinh H, Weekers L, Peeters P, Randon C, Bosmans JL, Roeyen G, Abramowicz D, Hoang AD, De Pauw L, Rahmel A, Squifflet JP, Pirenne J. Kidney donation after circulatory death in a country with a high number of brain dead donors: 10-year experience in Belgium. Transpl Int 2012; 25:857-66. [DOI: 10.1111/j.1432-2277.2012.01510.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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4
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Treska V, Kuntscher V, Hasman D, Neprasová P, Kobr J, Racek J, Trefil L, Hes O. Importance of selenium for the influence of ischemia-reperfusion syndrome after kidney transplantation from a non-heart beating donor in a pig model. Transplant Proc 2002; 34:3057-9. [PMID: 12493374 DOI: 10.1016/s0041-1345(02)03694-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- V Treska
- Department of Surgery, University Hospital Plzen, Plzen, Czech Republic.
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Metcalfe MS, Waller JR, Saunders RN, Veitch PS, Nicholson ML. Measuring intrarenal vascular resistance during machine perfusion preservation does not improve the assessment of renal viability made on clinical grounds. Transplant Proc 2001; 33:3745-6. [PMID: 11750596 DOI: 10.1016/s0041-1345(01)02529-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- M S Metcalfe
- Division of Transplant Surgery, University Department of Surgery, Leicester General Hospital, Leicester, United Kingdom
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6
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Valero R, Cabrer C, Oppenheimer F, Trias E, Sánchez-Ibáñez J, Cabo FMD, Navarro A, Paredes D, Alcaraz A, Gutiérrez R, Manyalich M. Normothermic recirculation reduces primary graft dysfunction of kidneys obtained from non-heart-beating donors. Transpl Int 2000. [DOI: 10.1111/j.1432-2277.2000.tb01086.x] [Citation(s) in RCA: 131] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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7
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Nicholson ML. Renal transplantation from non—heart-beating donors: opportunities and challenges. Transplant Rev (Orlando) 2000. [DOI: 10.1016/s0955-470x(00)80007-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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8
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Pokorny H, Rockenschaub S, Puhalla H, Blaicher W, Windhager T, Berlakovich GA, Steininger R, Mühlbacher F. Transplantation of kidneys from non-heart-beating donors: retrospective analysis of the outcome. Transplant Proc 1997; 29:3545-8. [PMID: 9414830 DOI: 10.1016/s0041-1345(97)01016-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- H Pokorny
- Department of Surgery, University Hospital Vienna, Austria
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9
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Daemen JH, de Wit RJ, Bronkhorst MW, Marcar ML, Yin M, Heineman E, Kootstra G. Short-term outcome of kidney transplants from non-heart-beating donors after preservation by machine perfusion. Transpl Int 1997. [PMID: 8959796 DOI: 10.1111/j.1432-2277.1996.tb01691.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
In this study, the short-term outcome of renal transplants from non-heart-beating donors (NHBD) preserved by machine perfusion (MP) is evaluated and compared to preservation by cold storage (CS). Twenty-two NHBD kidneys were procured during 1993 and 1994 after in situ perfusion with histidine-tryptophan ketoglutarate and preserved by continuous perfusion using University of Wisconsin organ preservation solution for MP as a perfusate. Between 1980 and 1992, 57 NHBD kidneys were procured and preserved by CS. Donors in the MP group sustained increased first warm ischemia times (WIT1) (P < 0.1) and recipients in the MP group suffered longer anastomosis time, worse HLA-DR mismatch, and more initial use of cyclosporin as immunosuppressant; all these factors are known to be deleterious to short-term outcome. Despite these unfavorable conditions, delayed function (DF) rate was decreased in the MP group, although not significantly. However, when considering only kidneys with WIT1 > or = 45 min, short-term outcome was significantly better in the MP group (P < 0.05). We conclude that MP is superior for the preservation of NHBD kidneys, especially after prolonged warm ischemia.
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Affiliation(s)
- J H Daemen
- Department of Surgery, University Hospital Maastricht, The Netherlands
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10
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Pacholczyk MJ, Lagiewska B, Szostek M, Chmura A, Morzycka-Michalik M, Rowińska-Stryjecka D, Wałaszewski J, Rowiński W. Transplantation of kidneys harvested from non-heart-beating donors: early and long-term results. Transpl Int 1997. [PMID: 8959797 DOI: 10.1111/j.1432-2277.1996.tb01693.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The purpose of this retrospective study was to evaluate results of non-heart-beating donor (NHBD) kidney transplantation. Between Jan 1986 and Dec 1994, 80 out of 582 cadaveric kidneys were harvested from NHBD (31.9 min +/- 24 after cardiac arrest). The results in the NHBD group (76 recipients) were compared with those obtained after transplantation of kidneys harvested from heart-beating donors (HBD) with respect to early graft function, and the graft and recipient's survival. Both groups were matched for sex, age, PRA level, number of HLA mismatches, and cold ischemia time. Triple immunosuppression therapy was used in both groups. Acute tubular necrosis (ATN) was observed significantly more frequently in the NHBD group (50 of 76 recipients vs 33 of 100 in the HBD group). The striking finding of this study was that the occurrence of primary non-function was the same in both groups and that the main cause of it was acute rejection. The 1-year patient and graft survival rates were 98.7% and 81.6% for the NHBD group and 99% and 90% for the HBD group, respectively. There was also no statistical difference in the serum creatinine concentration in both groups. We concluded that despite an increased incidence of ATN in the NHBD kidney recipients, the long-term results are good and comparable with those in the HBD group.
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Affiliation(s)
- M J Pacholczyk
- Department of General and Transplantation Surgery, Warsaw Medical School, Poland
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Candinas D, Largiadèr F, Binswanger U, Sutherland DE, Schlumpf R. A novel dextran 40-based preservation solution. Transpl Int 1996; 9:32-7. [PMID: 8748408 DOI: 10.1007/bf00336809] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Although the University of Wisconsin (UW) solution has become the standard solution for the preservation of kidneys for transplantation, the importance of the colloid hydroxyethylstarch (HES), one of the key compounds of the UW solution, has been questioned repeatedly. It is now established that HES is not necessary for routine kidney preservation. However, colloids may still be advantageous in UW like solutions for the purpose of multiorgan procurements and the preservation of organs from marginal donors. It has been shown in various experimental models that dextran 40 may successfully substitute for HES. Dextran 40 is not only cheaper but also has a variety of biological effects that may be beneficial during the graft reperfusion phase. The aim of this clinical study was to examine the efficacy of a dextran 40-based preservation solution (Dex-PS) for its use in human kidney graft preservation and to compare the transplantation results with kidneys preserved with UW solution. A total of 87 kidneys were preserved with Dex-PS and matched with 87 kidneys preserved with UW solution. Both groups were comparable in terms of donor and recipient characteristics and both had a high proportion of kidneys from nonheart-beating donors. Patient survival and graft survival after 1 year were 95% and 86% for the Dex-PS group and 94% and 90% for the UW group, respectively (P = NS). Primary nonfunction, delayed graft function, postoperative need for dialysis, and follow-up of serum creatinine were statistically comparable between these two groups. We conclude that dextran 40 can safely replace HES in UW solution for the purpose of clinical kidney preservation. There were no statistically detectable differences in graft performance between the kidneys preserved with UW and those preserved with Dex-PS.
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Affiliation(s)
- D Candinas
- Department of Surgery, University of Zurich Hospital, Switzerland
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12
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Pacholczyk MJ, Lagiewska B, Szostek M, Chmura A, Morzycka-Michalik M, Rowińska-Stryjecka D, Wałaszewski J, Rowiński W. Transplantation of kidneys harvested from non-heart-beating donors: early and long-term results. Transpl Int 1996; 9 Suppl 1:S81-3. [PMID: 8959797 DOI: 10.1007/978-3-662-00818-8_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The purpose of this retrospective study was to evaluate results of non-heart-beating donor (NHBD) kidney transplantation. Between Jan 1986 and Dec 1994, 80 out of 582 cadaveric kidneys were harvested from NHBD (31.9 min +/- 24 after cardiac arrest). The results in the NHBD group (76 recipients) were compared with those obtained after transplantation of kidneys harvested from heart-beating donors (HBD) with respect to early graft function, and the graft and recipient's survival. Both groups were matched for sex, age, PRA level, number of HLA mismatches, and cold ischemia time. Triple immunosuppression therapy was used in both groups. Acute tubular necrosis (ATN) was observed significantly more frequently in the NHBD group (50 of 76 recipients vs 33 of 100 in the HBD group). The striking finding of this study was that the occurrence of primary non-function was the same in both groups and that the main cause of it was acute rejection. The 1-year patient and graft survival rates were 98.7% and 81.6% for the NHBD group and 99% and 90% for the HBD group, respectively. There was also no statistical difference in the serum creatinine concentration in both groups. We concluded that despite an increased incidence of ATN in the NHBD kidney recipients, the long-term results are good and comparable with those in the HBD group.
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Affiliation(s)
- M J Pacholczyk
- Department of General and Transplantation Surgery, Warsaw Medical School, Poland
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13
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Candinas D, Largiadèr F, Binswanger U, Sutherland DER, Schlumpf R. A novel dextran 40-based preservation solution. Transpl Int 1996. [DOI: 10.1111/j.1432-2277.1996.tb00849.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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14
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Daemen JWU, de Wit AJ, Heineman E, Kootstra G. Kidney transplantation from non-heart-beating donors. Transplant Rev (Orlando) 1995. [DOI: 10.1016/0955-470x(95)80001-o] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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15
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Wijnen RM, Booster MH, Stubenitsky BM, de Boer J, Heineman E, Kootstra G. Outcome of transplantation of non-heart-beating donor kidneys. Lancet 1995. [PMID: 7715337 DOI: 10.1016/s0140-6736(95)90815-3] [Citation(s) in RCA: 244] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
To reduce the shortage of kidneys for transplantation, we started a non-heart-beating (NHB) donor programme, and compared the short-term and long-term outcomes of kidneys from NHB donors with those of a matched group of kidneys from heart-beating (HB) donors. 57 NHB kidneys were procured at the University Hospital in Maastricht and at three regional hospitals in the Netherlands, and were transplanted in 21 transplant centres within the Eurotransplant exchange organisation. 114 matched controls from HB donors were selected from Eurotransplant files. Mean follow-up was 85 months. At 5 years, graft survival was 54% for NHB kidneys and 55% for HB kidneys; patient survival was 75% and 77%. Kidneys from NHB donors had a significantly higher rate of delayed graft function (60% vs 35%), resulting in a longer hospital stay. Primary non-function of the graft was seen as frequently in the NHB donor-kidney group as in the HB group (14% vs 8%, p = 0.3). We conclude that NHB donors are a valuable source of kidneys for transplantation.
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Affiliation(s)
- R M Wijnen
- Department of Surgery, University Hospital, Maastricht, Netherlands
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