Comparison Between Kidney Transplantation After Circulatory Death and After Brain Death: A Monocentric Retrospective Study After 1 Year of Follow-up

Giacomo Mori,Andrea Solazzo,Laura Tonelli,Francesca Facchini,Francesco Fontana,Gaetano Alfano,Stefano Baroni,Gianni Cappelli

doi:10.1016/j.transproceed.2020.02.043

Abstract

BackgroundDonation after circulatory death (DCD) is a solid resource to widen the kidney donor pool. Italian activity has grown in the last years with encouraging results. Our center has been active in DCD kidney transplantation (KTX) since November 2017, providing 22.5% of Italian DCD donations in 2018. We present a single-center retrospective analysis after a 1-year follow-up comparing DCD and donation after brain death (DBD) KTX outcomes. MethodsDCD (controlled only) and DBD KTX performed in our center from November 2017 to December 2018 were considered. All DCDs underwent in situ normothermic perfusion with extracorporeal membrane oxygenation, ex situ hypothermic oxygenated perfusion, and renal biopsy prior to allocation.We considered features of donors and recipients, immunosuppressive regimen, delayed graft function (DGF), primary nonfunction (PNF), graft and patient survival (Kaplan-Meier), creatinine, and estimated glomerular filtration rate at 1 year. Mean comparison with a Student t test and with χ2 test for frequencies were elaborated. ResultsTwenty-eight DBD, 18 double (64.3%) and 10 single (35.7%), were performed; 7 DCD, 3 double (42.8%) and 4 single (57.2%), were performed. By comparing single and double KTX, no statistically significant difference was found. We recorded 7 DGFs (25%) in DBD and 1 (14.3%) in the DCD group (P > .99) and no PNF. No graft was lost during the first year. One-year estimated glomerular filtration rate (Chronic Kidney Disease Epidemiology Collaboration) was, respectively, 62.7 ± 25.3 and 54.71 ± 14.66 mL/min (P = .25). DBD patient survival rate was 92.8%, DCD was 100%, and Kaplan-Meier was not statistically significant (P = .72). ConclusionsControlled DCD is a valid resource for KTX, with similar outcomes to DBD. A multidisciplinary donor evaluation, combining clinical, perfusion, and histologic data in the allocation process, allows excellent results.

Highlights

MethodsDonation after circulatory death (DCD) (controlled only) and donation after brain death (DBD) KTX performed in our center from November 2017 to December 2018 were considered
Donation after circulatory death (DCD) is a solid resource to widen the kidney donor pool
Controlled DCD is a valid resource for KTX, with similar outcomes to donation after brain death (DBD)

Summary

Methods

DCD (controlled only) and DBD KTX performed in our center from November 2017 to December 2018 were considered. We considered features of donors and recipients, immunosuppressive regimen, delayed graft function (DGF), primary nonfunction (PNF), graft and patient survival (KaplanMeier), creatinine, and estimated glomerular filtration rate at 1 year. According to Italian law, a minimum of 20 minutes of isoelectric electrocardiogram must be recorded before cardiac death declaration. In this protocol, only cDCD are considered. In DBD, we performed kidney biopsy only in expanded criteria donors (ECD), defined either as subjects older than 65 years without comorbidities or younger but with comorbidities, such as hypertension, cerebral stroke, or high creatinine level (above 1.5 mg/dL).

Results

Discussion

Conclusion