Kidney Transplantation from Donation after Cardiac Death in China - A Clinical Analysis of 94 Cases

Abstract

Objective: To report clinical outcome of kidney transplantation (KTx) from donation after cardiac death (DCD) in China, and to investigate the feasibility of DCD utilization to expand organ donor pool in China. Patients and methods: Night-four DCD KTx were performed from February 2007 to March 2012 in two organ transplant centers in south of China. DCD donors were supported with or without extracorporeal membrane oxygenation (ECMO) to minimize ischemic injury. The clinical data of KTx recipients were retrospectively analyzed. There were 71 male and 23 female recipients with a mean age of 44 ± 11.3 years. All donor organs were evaluated before engraft. Results: The mean follow-up was 23.4 months, with a range from 53 days to 55.5 months. Delayed graft function (DGF) occurred in 27.7% (26/94) recipients, which recovered within 3 months after KTx, except two grafts were removed due to acute graft rupture and aneurysm, as well as one patient died of ruptured aneurysm two months after KTx. Six incidents of biopsy proved acute rejection (AR) were observed in five recipients (6.4%), five of which were reversed by pulse therapy and the other one resulted in dialysis. All patients survived through the follow-up except two who died of ruptured aneurysm or fulminant hepatitis-induced liver failure. The 1-year and 2-year graft survival rate were 96.8% and 94.7% respectively. Conclusion: Although kidney transplantation from DCD donors developed higher DGF with longer duration of graft recovery, favorable short-term clinical outcome was achieved in terms of graft survival rate and function. Donation after cardiac death could be feasibly utilized to expand organ donor pool in China.