Abstract
Background and objectives: Kidneys from donation after circulatory death (DCD) are more likely to be declined for transplantation compared with kidneys from donation after brain death (DBD). The aim of this study was to evaluate characteristics in the biopsies of human DCD and DBD kidneys that were declined for transplantation in order to rescue more DCD kidneys. Materials and Methods: Sixty kidney donors (DCD = 36, DBD = 24) were recruited into the study and assessed using donor demographics. Kidney biopsies taken post cold storage were also evaluated for histological damage, inflammation (myeloperoxidase, MPO), von Willebrand factor (vWF) expression, complement 4d (C4d) deposition and complement 3 (C3) activation using H&E and immunohistochemistry staining, and Western blotting. Results: More DBD donors (16/24) had a history of hypertension compared with DCDs (8/36, p = 0.001). The mean warm ischemic time in the DCD kidneys was 12.9 ± 3.9 min. The mean cold ischemic time was not significantly different between the two groups of kidney donors (DBD 33.3 ± 16.7 vs. DCD 28.6 ± 14.1 h, p > 0.05). The score of histological damage and MPO, as well as the reactivity of vWF, C4d and C3, varied between kidneys, but there was no significant difference between the two donor types (p > 0.05). However, vWF reactivity might be an early indicator for loss of tissue integrity, while C4d deposition and activated C3 might be better predictors for histological damage. Conclusions: Similar characteristics of DCD were shown in comparison with DBD kidneys. Importantly, the additional warm ischemic time in DCD appeared to have no further detectable adverse effects on tissue injury, inflammation and complement activation. vWF, C4d and C3 might be potential biomarkers facilitating the evaluation of donor kidneys.
Highlights
In the UK, approximately 12 to 15% of kidneys from deceased donors are retrieved, but declined for transplantation [1]
In the donation from brain death (DBD) kidneys, death was caused by an intracranial haemorrhage (ICH) in 88% of donors compared with 33% in the donation after circulatory death (DCD) group
Our findings suggest that the DCD kidneys declined for transplantation showed a similar level of histological injury (Table 3), inflammation (MPO + cells), complement complement 4d (C4d) deposition and complement 3 (C3) activation compared to DBD kidneys
Summary
In the UK, approximately 12 to 15% of kidneys from deceased donors are retrieved, but declined for transplantation [1]. There is considerable discrepancy amongst different centres in the criteria for accepting a kidney donor, as powerful indicators for assessing the quality of donor kidneys and facilitating clinical decision-making are lacking [3]. This means that many kidneys might be unnecessarily discarded. 17% of DCD kidneys are rejected for transplantation compared with 6% of kidneys from donation from brain death (DBD) donors in 2012 [1].
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