Kidney Transplantation from Uncontrolled Donors after Circulatory Death: Data from an Observational Cohort

• Published in: Transplantation Vol. 102 Suppl 7S-1; no. Supplement 7; p. S35
• Main Authors: Calvo Romero, Natividad, Perez Flores P, Isabel I, Rodriguez Cubillo R, Beatriz B, de la higuera M, M. Angeles M Moreno, Calvo Arevalo C, Marta M, Blazquez B, Jesus j, Gomez G, Angel A, Moreno m, Jesus J, Del Rio D, Francisco F, Sanchez Fructuoso S, Ana A
• Format: Journal Article
• Language: English
• Published: Copyright Wolters Kluwer Health, Inc. All rights reserved 01-07-2018
• DOI: 10.1097/01.tp.0000542588.41853.a0
• EISSN: 1534-6080
• ISSN: 0041-1337

Kidney transplantation from controlled donors after circulatory death (DCD) has substantially increased in Europe and the USA in the last decade, allowing for an increase in the amount of kidney transplants performed, obtaining good long-term results. However, there is scarce information on the long-term results of kidney transplantation from uncontrolled DCD (uDCD) We report the largest single-center series of kidney transplants from uDCD.
AIMTo analyze the factors that can be predictive of graft loss due to TMA in uDCD.
METHODSObservational cohort study that included all kidney recipients from uDCD (n=774) and from donors after brain death (DBD) (N=613) performed in our center between 1996 and 2015. Recipients from DBD were divided into two groupsstandard criteria brain death donors (SCBD) (n=366), and expanded criteria brain death donors (ECBD) (n=247). Clinical outcomes were compared.
RESULTSAfter the introduction of kidney transplantation from uDCD, the median waiting time on the kidney transplant list for patients in dialysis decreased from 25.1 months (IQR 13.0-54.9) to 12.9 months (IQR 5.6-24.8), and 107 patients were transplanted pre-emptively. One, 5 and 10-year graft survival rates for SCBD were 91.7%, 86.2% and 81.3% respectively versus 86.0%, 75.7% and 61.3% for ECBD and 85.1%, 79.2% and 73.3% for uDCD (p<0.001). Graft survival in transplants from uDCD donors was worse than those from SCBD (p=0.028) but better than in those from ECBD (p=0.028). The main cause of graft loss in uDCD was primary nonfunction, mainly due to thrombotic microangiopathy. Multivariate Cox regression analysis for graft loss (censored for death) showed an association between the presence of delayed graft function (DGF) and donor type. In presence of DGF, kidney transplant recipients from DBD had a higher risk of graft loss, both those from SCBD (HR 1.79 95% CI 1.08-2.99) and ECBD (HR 2.75,95% CI 1.67-4.51). In absence of DGF, recipients from ECBD had a higher risk of graft loss.