Kidney Graft Quality after Donation from Uncontrolled Deceased Donors after Cardiac Arrest

Abstract

Kidney grafts from uncontrolled deceased donors after cardiac arrest (uDDCA) have recently been used in France to counteract organ shortage. The quality of these kidneys remains debatable. The aim of our study was to compare the outcomes and the quality of uDDCA kidneys with that of kidneys from optimal donors such as simultaneous kidney and pancreas (SPK) donors and extended-criteria donors (ECD). 27 kidney grafts from uDDCA (mean donor age, 41) were compared with 24 kidney grafts from SPK donors (mean donor age, 26), and 30 kidney grafts from ECD (mean donor age, 66). All three patient groups were non-immunized and received the same induction and maintenance immuossupressive therapy. The quality of the grafts was assessed by renal function and histology. GFR was estimated by MDRD formula (eGFR) at M1 (n=80), M3 (n=80), M6 (n=79), M12 (n=74), M24 (n=70) and M36 (n=51) and measured by inuline clearance (mGFR) at M12 (n=66) and M36 (n=46). Interstitial fibrosis (IF) and vascular lesions were analyzed in systematic kidney biopsies at M3 (n=54) and M12 (n=50) with the Banff 2007 classification. IF was quantitatively measured by colour image analysis. Kidney graft quality from SPK group was always superior than the two others groups. In the short term, DGF in the uDDCA group was significantly higher than in the ECD group (table 1). In the uDDCA group renal function was initially poorer but improved during the first year. However on the long term, renal function and interstitial fibrosis was not different in uDDCA vs ECD group (table 2). Conclusion: Our study suggests that the quality of kidneys from uDDCA donors is similar to that of ECD and that these kidneys should be attributed to the same recipient population.[Table 1: Early results][Table 2: kidney graft function and histology]