Kidneys From Uncontrolled Donors After Cardiac Death Provide the Same Results as Kidneys Form Donors With Extended Criteria.

Abstract

Kidney donation after uncontrolled circulatory determination of death (uCDD) is an activity limited by logistical concerns and questioning concerning the evolution of the transplants. We have started the uCDD program in our two transplant centers since May 2008. All donors (n=35) were from Maastricht I and II categories, aged of 18 to 55 and presented a no flow period less than 30 min. In May 2011, in situ cold preservation was changed for normothermic regional extracorporeal circulation (NRC). Main recipient inclusion criteria were non sensitized patients, aged from 18 to 60 and awaiting first kidney transplantation. Fifty recipients from uCDD (G1) were compared to patients having received the transplants from standard (G2, n = 74) or extended criteria (ECD, G3, n=74) dead donors. One year patient and graft survivals were not significantly different between the 3 groups. PNF was more frequently observed in G1 (6% vs 0% and 2.7% in G2 and G3). The delay to obtain a sCreatinine below 250mmol/l was longer in G1 (21,5±11 days, vs 5±5 et 10±9 in G2 and G3, p<10-4). At one and two years after KTx, renal function was similar between G1 (178±68 and 166±67) and G3 (158±60 and 163±68 mmol/l) but remained significantly inferior compared to G2 (138±48 and 140±66 mmol/l, p<0.01). Finally, CNR use was associated with a shortened delay graft function time and an improvement of renal function at one year (145±35 vs 187±77 mmol/l). One year protocol graft biopsies (G1, n=24, G2, n=41 and G3, n=37) evidenced a more severe progression of arterial fibrous intimal thickening in G1 than in G2 or G3 but scoring for other histological lesions remained similar. The results of the KTx from uCDD program get closer to those from ECD. It seems coherent to propose these transplants to the recipients having the strongest probability to receive ECD transplants. However, the best quality of transplants taken under CNR will allow proposing these kidneys to younger recipients.