A single-center retrospective study of kidney graft survival after transplantation with a DCD-II donor kidney
N. Slebioda, L.B. Hilbrands, M.C. Baas
Chair(s): dr. M.A.C.J. Gelens
Thursday 9 march 2017
12:30 - 12:45h
Categories: Poster - Klinisch
Parallel session: Postersessie - Klinisch 4
Because of a shortage of kidney donors in the Netherlands, kidneys of donors after circulatory death with a witnessed cardiac arrest but unsuccessful resuscitation (Maastricht type II donor) are sometimes used to enlarge the donor pool. Not many data exist about the long-term graft survival.
The aim of this study was to evaluate the results of DCD-II kidney donors used between 1968 till June 2014 in a university hospital in the Netherlands. Data were collected from two different databases, the National Organ Transplant Registry (NOTR) and Eurotransplant (ET), and from patient files. 21 patients were identified as recipient of a DCD-II kidney transplant. The first transplantation with a DCD-II donor took place in July 1982. The median follow-up time is 5.1 years (range 0.1-19)
Median age of the donor was 30 years (range 13-66) and causes of death were trauma (n=12), myocardial infarction (n=4) and CVA (n=5). Median first warm ischemia time was 37 min (range 10-75), median cold ischemia time was 23.9 h (range 12.9-29.2), median second warm ischemia time was 37 min (range 16-164) and median total ischemia time was 25.2 h (range 15.3-30.5).
Median age of the recipients at the time of transplantation was 59 years (range 32 to 70). The most important causes of end-stage renal disease were polycystic kidney disease (n=6) and glomerulonephritis (n=6). 7 recipients were treated with peritoneal dialysis and 13 with hemodialysis before transplantation, 1 recipient was not treated with dialysis.
The 1-year, 5-year and 10-year graft survival rates were 76%, 60%, and 37%, respectively. The respective 1-year, 5-year and 10-year graft survival rates for DCD-III donor kidneys in the same period were 87%, 66%, and 48%.
Primary non function and delayed graft function occurred in 2 and 16 cases (9,5% and 76,2%).. The median duration of dialysis treatment during delayed graft function was 11 days (6-39). Acute graft rejection occurred in 8 cases (38%). The median eGFR after 3 months, 1 year, 5 years and 10 years was 44 (19-84)(n=17), 41 (23-78)(n=16), 42 (18-108)(n=12) and 47 (23-116)(n=7), respectively.
In the period between 1968 and June 2014 in 0.5% of the kidney transplantations a kidney from a DCD-II donor was used. Primary non function rate is high, however long term graft survival seems almost comparable to graft survival of DCD-III donor kidneys. We should continue to consider DCD-II donors as acceptable kidney donors as long as there is a shortage of donor organs.
