Kidney Transplants From Donors on Extracorporeal Membrane Oxygenation Prior to Death Are Associated With Better Long-Term Renal Function Compared to Donors After Circulatory Death.

Marilena Gregorini,Carlo Socci,Antonio Dell’Acqua,Stefano Malabarba,Vincenzo Sepe,Andrea Bottazzi,Elena Ticozzelli,Teresa Rampino,Eleonora F Pattonieri,Massimo Abelli,Rossana Caldara,Luciano De Carlis,Catherine Klersy,Carmelo Libetta,Alessandro Giacomoni,Maria A Grignano,Giuseppe Piccolo,Federica Manzoni

doi:10.3389/ti.2021.10179

Marilena Gregorini, Carlo Socci + Show 16 more

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https://doi.org/10.3389/ti.2021.10179

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Donation after circulatory death (DCD) allows expansion of the donor pool. We report on 11 years of Italian experience by comparing the outcome of grafts from DCD and extracorporeal membrane oxygenation (ECMO) prior to death donation (EPD), a new donor category. We studied 58 kidney recipients from DCD or EPD and collected donor/recipient clinical characteristics. Primary non function (PNF) and delayed graft function (DGF) rates, dialysis need, hospitalization duration, and patient and graft survival rates were compared. The estimated glomerular filtration rate (eGFR) was measured throughout the follow-up. Better clinical outcomes were achieved with EPD than with DCD despite similar graft and patient survival rates The total warm ischemia time (WIT) was longer in the DCD group than in the EPD group. Pure WIT was the highest in the class II group. The DGF rate was higher in the DCD group than in the EPD group. PNF rate was similar in the groups. Dialysis need was the greatest and hospitalization the longest in the class II DCD group. eGFR was lower in the class II DCD group than in the EPD group. Our results indicate good clinical outcomes of kidney transplants from DCD despite the long “no-touch period” and show that ECMO in the procurement phase improves graft outcome, suggesting EPD as a source for pool expansion.

Highlights

Organ shortage remains the main obstacle in kidney transplantation, there is an urgent need for donor pool expansion
We report our pragmatic experience over 11 years, comparing graft outcomes achieved with ECMO prior to death donation/donor (EPD) to those achieved with Donation after circulatory death (DCD)
From September 2008 to December 2019, 58 kidney transplants were performed; of which 36 kidneys came from DCD and 22 kidneys from EPD

Summary

INTRODUCTION

Organ shortage remains the main obstacle in kidney transplantation, there is an urgent need for donor pool expansion. A prolonged WIT is associated with a high rate of organ discard, primary non function (PNF), and delayed graft function (DGF) of kidney transplants from DCD, even if graft and recipient survival is comparable to that linked to donation after brain death (DBD) [4]. Due to these complexities, we sought to determine a particular type of donor from among the existing Maastricht categories. All tests were two-tailed and considered statistically significant at p < 0.05

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