LONG-TERM OUTCOMES OF RENAL TRANSPLANTATION FROM UNCONTROLLED AND CONTROLLED DONATIONS AFTER CIRCULATORY ARREST AT A TERTIARY CARE HOSPITAL IN INDIA

Abstract

Introduction: Donation after circulatory death (DCD) has never been attempted in India because of legal constraints and lack of guidelines for the withdrawal of life support in end-of-life situations. Renal transplantation from DCD donors was started in 2011 at our centre. The present report describes the outcomes of these transplants from Maastricht category IV and V donors at a tertiary care hospital in India. Methods: Between 2011 and 2019, 394 deceased donor transplants were performed at our centre. During this period, 14 donors had kidneys retrieved after circulatory arrest. These patients were declared dead after waiting for 5 min with no electrocardiographic signal on monitor following failed cardiopulmonary resuscitation (CPR), which was restarted in eight patients till organ retrieval. All donors received heparin and underwent rapid cannulation of aorta, infusion of preservative cold solution, and immediate surface cooling of organs during retrieval surgery. 25/28(89.2%) kidneys were utilized. Two kidneys were explanted due to refractory hypotension in a patient undergoing dual kidney transplant. Mean follow up duration was 40.2 + 20 months (Range 5.3 - 74 months) Results: Mean donor age was 32.8 ± 13.6 years, M:F 9:5 and mean age of recipients was 42.5 ± 11.3 years, M:F 14:10. 21/25 patients had delayed graft function and required dialysis in the postoperative period. Mean serum creatinine of 1.49 ± 0.38 mg/dl was achieved at the time of discharge at a mean duration of 32.2 ± 19.9 days. Kidneys from donors where CPR was continued after the declaration of death had earlier recovery of renal function (time to reach baseline creatinine 21.2 ± 7.2 vs. 34.3 ± 23.7 days). One kidney from the first uncontrolled DCD donor never functioned. For the remaining cohort of 23 patients, the mean creatinine at the last follow up was 1.26 ± 0.57 mg/dl. Patient survival was 100% and graft survival 95.8% at 1 year and 91.6% at the last follow up. Conclusion: Kidneys from DCD donors can provide good outcomes in the long term and serve as a useful adjunct in deceased donor program. Continuing CPR after the declaration of death hastens recovery of kidney function.