Experience in renal and extrarenal transplantation with donation after cardiac death donors with selective use of extracorporeal support.
BACKGROUND
Most reports of donation after cardiac death (DCD) donors are exclusive to kidney transplantation and report high rates of delayed graft function (DGF).


METHODS
From April 1, 2003, to October 3, 2007, we performed 53 kidney transplantations and 4 simultaneous kidney-pancreas transplantations from DCD donors. All DCD donor kidneys were managed with pulsatile perfusion preservation, and all simultaneous kidney-pancreas transplantation donors were managed with extracorporeal support.


RESULTS
Of 53 DCD kidney transplantations, 44 (83%) were from standard criteria donors (SCD) and 9 (17%) from expanded criteria donors (ECD). With a mean followup of 12 months, actual patient and kidney graft survival rates were 94% and 87%, respectively. Patient and graft survival rates were 100% in the 4 simultaneous kidney-pancreas transplantations. Incidence of DGF was 57% (60% without versus 20% with extracorporeal support, p = 0.036). Comparison of the 53 DCD donor kidney transplantations with 316 concurrent donation after brain death (DBD) donor adult kidney transplantations (178 SCD, 138 ECD) revealed no differences in demographics or outcomes, except that the DCD donor group had fewer ECDs (17% DCD versus 44% DBD; p = 0.0002), fewer 0-antigen mismatch kidney transplantations (7.5% DCD versus 19% DBD; p = 0.05), and more kidneys preserved with pulsatile perfusion (100% DCD versus 52% DBD; p < 0.0001). Incidences of DGF (57% DCD versus 19% DBD; p < 0.0001) and acute rejection (19% DCD versus 10% DBD; p = 0.10) were higher in the DCD donor group, which resulted in a longer initial length of stay (mean 11 days DCD versus 8.0 days DBD; p = 0.006).


CONCLUSIONS
Despite a high incidence of DGF in the absence of extracorporeal support and greater initial resource use, comparable short-term results can be achieved with DCD and DBD donor kidney transplantations.
Farney
Alan C
AC
Department of General Surgery, Wake Forest University Baptist Medical Center, Winston-Salem, NC 27157-1095, USA. afarney@wfubmc.edu
Singh
Rajinder P
RP
Hines
Michael H
MH
Rogers
Jeffrey
J
Hartmann
Erica L
EL
Reeves-Daniel
Amber
A
Gautreaux
Michael D
MD
Iskandar
Samy S
SS
Adams
Patricia L
PL
Stratta
Robert J
RJ
D000328:Adult; D000368:Aged; D003643:Death; D051799:Delayed Graft Function / Q000209:etiology*; D005112:Extracorporeal Circulation; D005260:Female; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D016035:Pancreas Transplantation; D010477:Perfusion; D012189:Retrospective Studies; D014019:Tissue Donors; D020858:Tissue and Organ Harvesting / Q000379:methods*