Functional Outcomes of the Renal Transplants Obtained from Controlled Donation Following Cardiopulmonary Death (DCD) with Compartmental Normothermic Extracorporeal Membrane Oxygenation Support (NECMO)

Abstract

Introduction Since the implementation of the DCD protocol at our institution in 2012, some modifications have taken place in order to improve the organ viability. As for this, the NECMO has proven to be an effective method and to help reduce the ischemic organ damages. Objectives To analyse the functional outcomes of the transplanted kidneys (TK) obtained from DCD using NECMO. Methods We have reviewed the results from 15 kidney transplants (KT), whose organs where obtained from 9 DCD using NECMO as the preservation method, from 2015 to 2017 at our institution. Currently, in our protocol, arterial and venous femoral canulae and the aortic occlusion balloon catheter are placed in the operating room, on a premortem and setup. We have assessed the donors and recipient characteristics and also the TK outcomes, using a descriptive method from all our data available. Results From the 9 DCD, we have obtained 15 valid kidney grafts, who were transplanted at our institution, just one was not suitable due to anatomic alterations. The other 2 allografts were offered to other Hospitals. Donor age averaged 52 years and allografts recipients averaged 48 years. Four patients (26%) underwent previous kidney transplant, with an overall kidney allograft survival of 13.4 years. Prior to KT, 13% were on a pre-dyalisis basis and the remaining 86% were on renal replacement therapy for an average of 14 months. Cardiopulmonary death occurred within an average of 12.2 minutes following withdrawal of life support. From the 15 KT, 13 (83%) continue to function, 1 had arterial thrombosis which led to transplantectomy and the other suffered acute rejection. The 6 month average Cr was 1.6mg/dL. Delayed graft function, defined as at least one postoperative episode of dialysis, occurred in 40% of kidneys (6/15). Conclusion 1- The organ quality from DCD is comparable to brain death donors. 2- ECMO supported DCD is feasible and easily implemented if necessary resources are available 3- Helps optimizing the donation-renal transplant process as the medical team responsible is involved.