DCD Kidneys Research Articles

Increased Circulatory Death Donation Rates: Which Patients Are Benefiting?

Introduction: UK DCD rates have increased six-fold in the last 7 years, but it is not clear who benefits from DCD kidney transplants, particularly as the mean age of DCD donors is increasing and DCD kidney allocation is exempt from the national scheme. This study examines donor profile and outcomes according to age at listing for renal transplantation in our centre, where twice as many DCD as DBD kidney transplants are currently performed. Methods: Outcomes of adult patients listed for renal transplantation between 2002 and 2012 were analysed. Patients were divided into three groups according to age at time of listing: <45, 45-65 and >65 (elderly). Times of listing, delisting, death and transplant details were recorded; DCD organs were allocated using a modification of the national algorithm, which favoured age-matching donor and recipient. Results: Of those listed for renal transplantation (1386), 559 were aged under 45, 691 were 45-65 and 136 were over 65, with 74%, 70% and 53%, respectively, receiving a transplant. The proportion of elderly patients listed increased from 6% in 2002 to 13% in 2012. Elderly patients had the highest rate of delisting (p<0.001): only 7% of untransplanted patients who had been listed in the first 6 years were active on the list at time of follow-up (cf 15% 45-65, 24% <45). Despite the preferential national allocation of DBD organs to younger, HLA-matched, recipients, there was no significant difference in time to transplantation between the three groups, likely because whereas younger patients received an equal proportion of organs from DBD, DCD and live donors, older patients received a much higher proportion of DCD kidneys (64% in the >65 group, p<0.001). This reflects local bias of allocating elderly DCD kidneys to elderly patients; 30% of kidneys from DCD donors over 65 were allocated to recipients over 65 (cf 20% of kidneys from comparable DBD donors). This bias has, however, a limited impact on overall DCD usage, because only 12% of all DCD kidneys were allocated to the over 65 group (of which half were from donors over 70). There was no significant difference in graft survival between the three groups when censored for death as a cause of graft loss. Conclusions: The time-frame for transplantation of elderly patients is limited. As numbers listed increase, preferential allocation of older DCD kidneys to this population may alleviate demand with minimal effect on the overall donor pool.

DCD Kidneys Are Associated With Inferior eGFR But Equivalent Outcomes to DBD Kidneys.

DCD Kidneys Are Associated With Inferior eGFR But Equivalent Outcomes to DBD Kidneys.

The Incidence of Delayed Graft Function Requiring Dialysis Can Be Reduced to &lt; 10% By a Composite Strategy.

BACKGROUND: A strategy to minimize incidence of delayed graft function requiring dialysis (DGFRD) is desirable to reduce clinical and economis impacts. METHODS: We used a strategy to minimize DGFRD in all 131 adult deceased donor kidney alone transplants performed at our center between 1/1/2009 and 12/31/2012: All the organs were perfused; cold ischemia time (CIT) was minimized; thymoglobulin was used as an induction agent with 1st dose intraoperatively; tacrolimus was delayed for at least 48 hours; and efforts were made to maintain urine output > 100 ml/hour with IV diuretics. Demographics, SCD/ECD/DCD status, and CIT were studied. Primary outcome was DGFRD; other outcomes were length of stay (LOS), patient survival (PS), graft survival (GS), and GFR at 6 months after transplant and at the end of follow-up (6/30/2013). RESULTS: Median follow-up was 27±13 (7.3-54.5) months. Five patients were excluded (1 death and 4 for mechanical complications within a week of transplant). Six of the remaining 126 (4.8%) patients developed DGFRD.Table: No Caption available.One of 21 DCD (4.8%) kidney recipients developed DGFRD. There was no significant difference in GFR at 6 months and at the end of follow-up between DGFRD and and non-dialyzed patients. LOS was significantly longer in DGFRD patients. CONCLUSION: DGFRD can be reduced with our strategy.

Substantial Increases in Deceased Donor Transplant Rates Could Be Achieved By Altering the Thresholds for Accepting Marginal Donors.

Introduction: Expansion in donor numbers has not realised a proportional expansion in transplant numbers.Here we examine how alterations in the numbers and quality of cadaveric liver, pancreas and kidney offers between 2005 and 2012 have impacted upon transplant activity at a single UK centre. Methods: A retrospective review of offers to our centre from April 2005 to March 2012 was performed. Donor characteristics, and numbers of kidney, liver and pancreas offers were recorded. As a marker for organ ‘quality', the organ-specific ‘donor risk index' (DRI) for organs offered and implanted was calculated. Results: A total of 5628 organs were offered, with numbers increasing substantially, from 392 in 2005 to 1230 in 2012. This largely reflects an expansion in DCD offers; with the proportions of DCD kidney, liver and pancreas offers increasing from 19% to 77%, 6% to 64%, and 1%-62%, respectively.Transplant numbers for each organ have also increased, but more modestly (kidneys 68-127, livers 57-96, pancreases 4-22), with a significant increase in the mean DRI for each organ (p<0.001). Whilst in 2005 the mean DRI of organs offered was similar to those implanted, by 2012 the DRI for all organ types offered was significantly higher than that of those used. This is not solely due to changes in practice regarding DCD organ usage, because the DRI for kidneys implanted, which is not influenced by donor type, similarly increased during the study period. Despite the progressive use of more marginal organs, there was no observed difference in one-year graft survival from 2005 to 2011 [kidney (HR 0.42, 95% CI 0.8-2.25), liver (HR 1.07, 95%CI 0.43-2.65), pancreas (HR 1.47, 95% CI 0.1-2.18)]. Conclusions: Although we are transplanting more ‘marginal' organs, there is an increasing discrepancy in the number and quality of organs offered to those used. Further increases in transplant numbers will likely require greater use of the large pool of marginal donors that are currently declined; the consistent survival times achieved for the organs implanted throughout the study period suggest that there may be potential to do so safely.

Long-Term Graft Survival Was Affected By Several Donor’s Factors in Renal Transplants Engrafting DCD Kidneys. - Based On Data From a Single Center Having Recovered Over 500 DCD Renal Grafts.

Long-Term Graft Survival Was Affected By Several Donor’s Factors in Renal Transplants Engrafting DCD Kidneys. - Based On Data From a Single Center Having Recovered Over 500 DCD Renal Grafts.

Supplementation of Kidney Machine Perfusion With a New Oxygen Carrier to Improve Renal Graft Performance in a DCD Porcine Model.

Italian regulation requires 20 minutes of an isoelectric EKG registration after cardiac death,this raises issues on injury due to prolonged warm ischemia time (WIT) of DCD kidney. To address this,many procedures are adopted including ex vivo reconditioning on pulsatile Machine Perfusion (RM3TM-MP). Aim of this study was to evaluate the benefit of providing O2 to kidney during ex vivo reperfusion on post-ischemic recovery of graft function.The naturally respiratory pigment M101 (HEMO2Life®,HEMARINA SA)that releases O2passively,and which is effective at hypothermia,was added during MP;clinical and histological parameters were assessed after autologous KidneyTx.Methods:Landrace swine were randomized in experimental groups (N=4/group)as described in Table1.The model consists in a 75-min in situ WI followed by left kidney removal and a 10-hour hypothermic preservation period.Then, autologous Tx followed by contro-lateral nephrectomy was performed.Sacrifice was performed after 14 days.Endpoints were:kinetic of serum creatinine levels,histology samples.Table: No Caption available.Results: Values are expressed as mean±SD and analysed by Student's t-test. Creatinine values in MP + HEMO2Life®(Figure 1)were significantly lower compared to MP alone at day 6 (p=0.01) and compared to CS group at day 4 and day 5 (p=0.03 and 0.01), showing a faster recovery of kidney function.Despite these positive results, no major differences were found in histological features.Figure: No Caption available.Conclusions: Addition of HEMO2Life® in MP preservation significantly improved post-ischemic recovery of kidney function in a swine model of DCD.Deeper ultra-structural and biochemical analysis are underway in order to elucidate mechanisms of this protective effect. These preliminary data open new perspective on the benefit of HEMO2Life® in reconditioning of kidneys.

Novel Candidate Biomarkers of DCD Warm Ischaemia.

Introduction There is an increase in the use of DCD kidney allografts in the UK. Organ dysfunction (delayed graft function, DGF and primary non-function, PNF) post-transplantation is thought to be related to warm ischaemia (WI) exposure during retrieval. We used an experimental model of DCD WI to establish potential candidate biomarkers that could aid DGF and PNF prediction. Methods Post-termination renal biopsies were taken from large white pigs at 30 min intervals upto 180 min. Extracted total RNA and proteins were subjected to genomic (expression microarray & qPCR) and proteomic (2D-DIGE & Western blot) analysis. Expression trends were interrogated with ANOVA and linear regression. Results HSP70 upregulation was significant across the 3 hour WI period at the gene (Fold change (FD) +4.1, p<0.01, (Fig 1)) and protein (FD +2.1, p<0.01) level. Linear regression demonstrated a strong association with WI time (R2 0.61, p<0.001). Peroxiredoxin-3 and -6 were upregulated with a FD of +1.8 (PRX3 and -6, p=0.03 and 0.02 respectively). Gene expression of ß-tubulin (TUBB2a) demonstrated significant downregulation after 30 min WI with a strong correlation to WI time (R2 of 0.74, p<0.001)(Fig 2). ß-actin (ATB), was also downregulated across the WI period at the protein and gene level (FD 1.3, P<0.05).Figure: No Caption available.Conclusions Linear regression of candidate markers of WI demonstrated a significant association with DCD WI time. Downregulation of the cytoskeletal proteins ATB and TUBB2a indicate microtubular depolarization, which may indicate the onset of cell death. Gene and protein upregulation of HSP70 with the antioxidants PRX3 and PRX6 reflect cellular stress. These are novel findings of DCD WI. The linear association of HSP70 and TUBB2a with WI time warrants further investigation as potential candidate markers of cellular viability.

Outcome and Cost Analysis of Induction Immunosuppression With IL2Mab or ATG in DCD Kidney Transplants

Kidney transplantation from DCD now represents a significant part of the overall transplant activity in the UK. Outcome of different induction immunosuppression regimes and related cost benefit analysis has been reported by very few studies.This is a single centre study on frequency-matched patients who received a DCD kidney transplant between August 2007 and August 2009. Data on 45 patients divided in 2 groups were collected prospectively and analyzed retrospectively. Group A (24 patients) received IL2Mab and Group B (21 patients) ATG as induction immunosuppression. Patient and graft survival were similar in both groups. In the ATG-induced group, there was a significant lower rate of DGF, BPAR, and infections requiring readmission.A cost analysis was performed including all immunosuppression-related costs, and it has shown remarkable savings in the ATG-induced group. Considering that the number of DCD kidney transplants is destined to rise in the UK, we believe that ATG is a valid option to continue optimizing outcomes of DCD kidney transplant. In our experience, ATG proved to be safe, effective, and contributed to significant cost savings.

Ischemic postconditioning in human DCD kidney transplantation is feasible and appears safe

Ischemic postconditioning may improve outcome after kidney transplantation. We performed a pilot study to assess feasibility and safety of ischemic postconditioning in human donation-after-circulatory-death kidney transplantation. Twenty patients were included. Primary outcome was rate of serious adverse events. Secondary outcomes were incidence of DGF and renal function at 3 months. Data were compared to a historical control group (n = 40). Furthermore, we performed a paired kidney analysis using the contralateral kidney (n = 11). Donor age and serum creatinine were higher in the experimental group compared with historical control: 57.7 (20-71) vs. 51.5 (24-74) years (P = 0.01) and 79 (40-156) μmol/l vs. 64 (25-115) μmol/l (P = 0.047). Postconditioning could be applied all times. One complication, a venous tear, occurred related to postconditioning. The experimental group experienced more DGF (85% vs. 63%) (P = 0.07). Serum creatinine at month 3 was 166 (109-331) μmol/l vs. 159 (81-279) μmol/l (P = 0.71). Paired kidney analysis showed no significant differences in DGF (72.2% vs. 54.5%, P = 0.66) and serum creatinine 199 (90-473) μmol/l vs. 184 (117-368) μmol/l (P = 0.76). This is the first report of applying IPoC in human kidney transplantation. Although IPoC is feasible and appears to be safe, no benefit in terms of reduced DGF or better renal function was observed (Dutch trial registry number NTR 3117).

Benefits of active oxygenation during hypothermic machine perfusion of kidneys in a preclinical model of deceased after cardiac death donors

BackgroundDeceased after cardiac death donors (DCDs) represent a valuable source of organs; however, preventing poor outcome is difficult, even with the use of machine perfusion (MP). It is of paramount importance to improve this method. We proposed to evaluate the benefits of active oxygenation during kidney graft hypothermic MP using a novel perfusion machine: Kidney Assist (KA). MethodsWe used a pig model of DCD transplantation in Large White pigs. Cold preservation was performed by conventional non-oxygenated MP (KAnoO2) or oxygenated MP (KA). ResultsIn the first 2 wk post-transplant, KA grafts displayed a lower serum creatinine peak and a faster return to normal levels compared with KAnoO2 animals, translating into a smaller area under the curve. Urinary neutrophil gelatinase-associated lipocalin levels and serum aspartate amino transferase levels were lower in KA animals compared with the non-oxygenated group. These correlated with better chronic function. Longer follow-up of the animals (3 mo) permitted evaluation of chronic outcome lesions. Interstitial fibrosis was reduced in the KA group, and these kidneys also displayed significantly lower levels of vimentin staining. Further histologic investigation also showed a trend toward decreased chronic inflammation in kidneys preserved with oxygen. ConclusionsThis new MP system is efficient in preserving DCD kidneys, greatly enhancing the capacity of the graft to withstand preservation stress and improving outcome. Oxygen delivery during preservation is thus valuable for highly damaged organs and offers an important therapeutic tool for transplant teams faced with decreased quality of donor organs.

Hypothermic Machine Perfusion Preservation of the DCD Kidney: Machine Effects

Purpose. Kidneys from DCD donors represent a significant pool, but preservation problems exist. The study objective was to test the importance of machine type for hypothermic preservation of DCD kidneys. Methods. Adult Beagle dog kidneys underwent 45 minutes of warm in situ ischemia followed by hypothermic perfusion for 24 hours (Belzer-MPS Solution) on either an ORS LifePort or a Waters RM3 using standard perfusion protocols. Kidneys were then autotransplanted, and renal function was assessed over 7 days following contralateral nephrectomy. Results. Renal vascular resistance was not different between the two pumps. After 24 hours, the oxygen partial pressure and oxygen delivery in the LifePort perfusate were significantly lower than those in the RM3 but not low enough to change lactate production. TheLifePort ran significantly colder than RM3 (2° versus 5°C). The arterial pressure waveform of the RM3 was qualitatively different from the waveform of the LifePort. Preservation injury after transplantation was not different between the devices. When the LifePort was changed to nonpulsatile flow, kidneys displayed significantly greater preservation injury compared to RM3. Conclusions. Both LifePort and RM3 can be used for hypothermic machine perfusion preservation of DCD kidneys with equal outcomes as long as the duty cycle remains pulsatile.

Old DCD Kidneys to Old Recipients Have An Excellent Outcome; Have We Found the Solution for the Old Patients on the Waiting List?

Introduction: Controlled DCD kidneys represent a valuable source of kidney transplants and in UK represent up to 30% cadaveric kidney transplants. Traditionally DCD kidneys for older donors were either not retrieved or their offer rejected due to fears of marginal renal reserve and very high primary non function (PNF). Older recipients over the age of 65 years represent more than 25% of the total transplant waiting list in our centre. On the basis of that we expanded significantly the acceptance criteria for DCD kidney donors so they now represent 60% of our cadaveric program and 40% of our overall program. Aim and Methods: The aim of this study is to present the preliminary results of the program of transplanting older donor (>60 years old) DCD kidneys to older (>60 years old) recipients to see if it is an appropriate use of these extra resource of organs. Results: In a 2 years period there were 125 DCD donors. Out of them 42 (34% of DCD) were from donors over 60 years old and were transplanted in recipients over 60. Median age of those donors was 69 (range 61-80) years (with 30 of those donors over 65), whereas the median recipient age was 68 (range 60-80) years. Median follow up was 6.5 months. The delayed graft function (DGF; defined as need for dialysis in the first week) was seen in 23 patients (55%) and it lasted a mean of 7.5 days. There was 1 case of PNF (2.4%) and 2 cases of graft failure, one at 3 months due to poor function and one at 6 months. There was 1 sudden cardiac death at home in a 70 years old patient with a GFR of 41at 3 months post transplant. There were 2 acute rejections (5%). MDRD GFR was as follows: Table 1This compares favourably with the 1 year MDRD GFR in all DCD recipients (irrespective of donor or recipient age) of 46 ml/min/1.73m2. Conclusion: Older DCD donors represent an excellent source of transplant kidneys. They have a low PNF, a low rejection rate and a good (at least) short term survival when transplanted in older recipients. The one year kidney function of these kidneys in old recipients is as good as the one year results of all DCD kidneys irrespective of donor and recipient age. Our preliminary results support the use of those ‘marginal’ kidneys in this recipient group.

Does National Sharing of DCD Kidneys Lead to Poorer Outcomes?

Background: DCD kidneys represent an increasing proportion of transplant activity. There have been concerns that wider sharing of these kidneys increases the cold ischaemic time and leads to poorer outcomes. Methods: DCD kidney transplantation was introduced in practice in Scotland in 2005, each centre transplanting locally donated DCD kidneys. A national sharing scheme of DCD kidneys has been introduced in 2007, whereby kidneys are shared equally between the two renal transplant centres in the country (one is also a liver and pancreas transplant unit). A national multi-organ team carries out DCD retrievals throughout Scotland and one kidney is shipped directly to each of the two units. Donor and recipient demographic data, cold ischaemic time data and outcome data have been prospectively collected. Outcome and cold ischaemic times were compared within each centres and between centres pre-and post-introduction of the sharing policy. Results: Since 2005, 152 DCD kidney transplants have been performed in Scotland. 68 kidneys were shared as pairs since 2007. There were not differences between the recipient demographics (gender, age and BMI) before and after the introduction for the sharing scheme. The cold ischaemic time (CIT) was significantly higher in Glasgow (14.30±3.79 hours) compared with Edinburgh (10.72±2.99 hours), (p< 0.001, One-way ANOVA) prior to the introduction of the sharing scheme. Following the implementation of kidney sharing, there has been no significant difference in CIT between Glasgow and Edinburgh (10.50±3.34 hours vs.10.53±2.71 hours). Furthermore, a significant reduction in the CIT in Glasgow, from 14.30±3.79 hours to 10.50±3.34 hours (p< 0.001, one-way ANOVA) was noted after sharing was instituted. A smaller, statistically non-significant, reduction in the CIT was noted in Edinburgh. Patient and graft survival before and after the introduction of the scheme was comparable in both centres. The incidence of acute rejection (12.5%) and delayed graft function (defined as need for dialysis within 1st week post-transplant) (63.2%) has not changed with the introduction of the scheme and was also comparable in both centres. One-year creatinine in Glasgow DCD recipients was 105.36±44.70 μmol/L compared with 141.75±43.50 μmol/L in Edinburgh (p>0.05). Conclusion: Wider sharing of DCD kidneys should be encouraged as it does not compromise clinical outcomes. Furthermore, a transparent and well established sharing agreement, with no delays in the offering of DCD kidneys, has shown an improvement in cold ischaemic time in one of the centres.

Hypothermic Machine Preservation in Comparison with Static Cold Storage of Kidney Allografts: A Systematic Review and Meta-Analysis

Introduction: There is renewed interest in Hypothermic Machine Perfusion (HMP) of kidneys in recent years with the development of a new generation of pumps. However, it remains controversial which method is most beneficial for the transplant recipient. A systematic review of the level of available evidence comparing HMP with SCS and a statistical analysis of the combined data was performed. Methods: A systematic literature search was performed using MEDLINE (1948 to October 2011), EMBASE (1980 to October 2011), the Cochrane Library, the Transplant Library of RCTs from the Centre for Evidence in Transplantation and the International Clinical Trials Registry Platform. Studies were assessed for methodological quality. Summary effects of meta-analysis are presented as Relative Risks (RR) and 95% Confidence Intervals (95%CI). RCTs alone were used for meta-analysis. Results: Nineteen studies met the full inclusion criteria, including 7 RCTs and 12 Non-RCTS with a total of 2,086 kidneys. The overall risk of Delayed Graft Function (DGF) was lower with HMP than with SCS (fixed effects, RR=0.81, 95%CI=0.70-0.92, p< 0.01). DGF was not significantly reduced when results were split into DBD kidneys (fixed effects, RR=0.84, 95%CI=0.68-1.04, p=0.10) and DCD kidneys (fixed effects, RR=0.80, (95%CI=0.62-1.04, p=0.09). There was no evidence that the effect on DGF comparing these two donor types was significantly different (Test of Interaction, p=0.78). There was no difference in the risk of graft loss within the first 12 months (fixed effects, RR=0.86, 95%CI=0.68-1.09, p=0.22) or the rate of Primary Non-Function (PNF) between HMP and SCS kidneys (random effects, RR=1.16, 95%CI=0.46-2.94, p=0.75). Three studies found a faster fall in serum creatinine for HMP preserved kidneys in the first 14 days; however 3 studies found no significant difference in longer term renal function (30-365 days). Rates of acute rejection were equal in 2 studies, although higher following SCS in 1 study. In the 7 studies that reported patient survival there was no relationship between preservation method and this outcome. Conclusion: Data from the included studies shows that HMP reduces DGF compared to SCS. This effect may be the same in both DBD and DCD kidneys. HMP may lead to a quicker reduction in serum creatinine post-op. There was no difference in graft loss in the first 12 months, PNF, long term renal function, acute rejection or patient survival. Figure: Forest plot to show RR of DGF comparing hypothermic machine perfusion (HMP) to static cold storage (SCS) in randomised controlled trials. N= total patients in study arm, n= number of patients with DGF. Summary RR calculated by fixed effects meta-analysis, < 1 Favours HMP. 95%CI=95% confidence interval.Figure: [Forest plot to show relative risk (RR) of DGF.]

Hypothermic Machine Perfusion Improves Outcomes in DCD Kidneys with Long Cold Ischemia Time

Hypothermic Machine Perfusion Improves Outcomes in DCD Kidneys with Long Cold Ischemia Time

Are DCD Kidneys More Susceptible to Age-Related Kidney Damage and Ischaemic Injury?

Are DCD Kidneys More Susceptible to Age-Related Kidney Damage and Ischaemic Injury?

Impact of Machine Perfusion Parameters on Renal Graft Outcomes

Introduction: The aim of the study is to evaluate the machine perfusion parameters as decision making tool in discarding cadaveric kidneys. Methods: Data was collected for all the kidneys preserved with Machine Perfusion (MP) from May 2008 till January 2012. Kidneys were perfused with KPS1 using Life port machine. Machine perfusion parameters were downloaded from Organ Recovery System data station and clinical data was retrieved from prospectively maintained database. Results are expressed as means and percentages. P values were calculated by Chi-square test or Fisher's Exact test as appropriate (< 0.05 is considered statistically significant). Results: A total of 138 kidneys were machine perfused during the study period. Of these 14 were discarded; 2 for renal cell cancer, 3 for vascular injury and 9 for poor perfusion parameters (high resistance, low flow). 124 kidneys were implanted, 13 of them were implanted in seven pairs of dual kidneys whilst the rest were implanted as single grafts. 44 DBD and 80 DCD kidneys were machine perfused. The mean resistance at the termination of perfusion (TR) in both the groups was similar 0.27 vs. 0.26 respectively. Based on resistance the kidneys were divided into three groups Group I: TR < 0.4 (n=106), Group 2: TR = 0.4 to -0.6 (n=12), Group 3: TR ≥ 0.6 (n=6). Primary function (PF) was 57, 58 and 50 % in the three groups respectively (p=1.000). DGF rate was 37.7% (p=0.765), 41.7% (p=0.677) and 50.0% (p=1.000) in group 1, 2 and 3 respectively. Only one PNF was observed in Group 1. One year graft survival (GS) was 92.5%, 91.7% and 83.3%. When graft outcomes were compared to the duration of machine perfusion (table1) and the MP proportion of CIT (table 2), no differences were detected.Table: No Caption available.Table: No Caption available.Conclusion: High resistance values, duration of MP and proportion of MP as function of total CIT do not impact on graft outcome. High resistance values on machine perfusion should not be used as standalone guide to discard kidneysion (table1) and the MP proportion of CIT (table 2), no differences were detected.

Economic Analysis of DBD Versus DCD Kidney Transplantation - Is Higher DCD Costs Justified?

Economic Analysis of DBD Versus DCD Kidney Transplantation - Is Higher DCD Costs Justified?

Impact of Machine Perfusion Parameters on Renal Graft Outcomes

Introduction: The aim of the study is to evaluate the machine perfusion parameters as decision making tool in discarding cadaveric kidneys. Methods: Data was collected for all the kidneys preserved with Machine Perfusion (MP) from May 2008 till January 2012. Kidneys were perfused with KPS1 using Life port machine. Machine perfusion parameters were downloaded from Organ Recovery System data station and clinical data was retrieved from prospectively maintained database. Results are expressed as means and percentages. P values were calculated by Chi-square test or Fisher's Exact test as appropriate (< 0.05 is considered statistically significant). Results: A total of 138 kidneys were machine perfused during the study period. Of these 14 were discarded; 2 for renal cell cancer, 3 for vascular injury and 9 for poor perfusion parameters (high resistance, low flow). 124 kidneys were implanted, 13 of them were implanted in seven pairs of dual kidneys whilst the rest were implanted as single grafts. 44 DBD and 80 DCD kidneys were machine perfused. The mean resistance at the termination of perfusion (TR) in both the groups was similar 0.27 vs. 0.26 respectively. Based on resistance the kidneys were divided into three groups Group I: TR < 0.4 (n=106), Group 2: TR = 0.4 to -0.6 (n=12), Group 3: TR > 0.6 (n=6). Primary function (PF) was 57, 58 and 50 % in the three groups respectively (p=1.000). DGF rate was 37.7% (p=0.765), 41.7% (p=0.677) and 50.0% (p=1.000) in group 1, 2 and 3 respectively. Only one PNF was observed in Group 1. One year graft survival (GS) was 92.5%, 91.7% and 83.3%. When graft outcomes were compared to the duration of machine perfusion (table1) and the MP proportion of CIT (table 2), no differences were detected.Table: No Caption available.Table: No Caption available.Conclusion: High resistance values, duration of MP and proportion of MP as function of total CIT do not impact on graft outcome. High resistance values on machine perfusion should not be used as stand-alone guide to discard kidneysion (table1) and the MP proportion of CIT (table 2), no differences were detected.

Kidney Transplantation From Donation After Cardiac Death Donors in China—A Single-Center Experience

ObjectiveTo report clinical outcomes of kidney transplantation from cardiac death donors (DCD) in China, and to investigate its feasibility to expand the organ donor pool. Patients and methodsWe retrospectively studied clinical data of 46 DCD kidneys from 31 donors from February 2007 to August 2011. Recipients were followed for patient and graft survival. ResultsWe discarded the organs from 3 of 29 (10.3%) DCD donors and 7 of 42 (16.7%) kidneys that displayed renal thrombosis. Of the 39 recipients engrafted with DCD kidneys successfully, the mean follow-up was 16 months, (range = 50 days to 43 months). Delayed graft function (DGF) occurred in 15 (38.5%) recipients, who except one recovered within 3 months. Three biopsy-proven acute rejection episodes were observed in two recipients (5.1%). All patients survived through the follow-up. The graft survival rate was 97.4% at 12 months and 94.9% at 24 months. A 45-year-old male recipient who received a pair of grafts from a 6-year-old child survived with good renal function. ConclusionAlthough kidney transplantations from DCD donors showed a higher rate of DGF with a longer duration of graft recovery, we achieved favorable short-term clinical outcome in terms of graft survival and function. Donation after cardiac death can expand the organ donor pool in China.