title: Sequential transplant of paired kidneys following donation after cardiac death: impact of longer cold ischemia time on the second kidney on graft and patient outcome.
abstract: The United Kingdom has no national sharing scheme for kidneys received from donation after cardiac death (DCD). Therefore, both kidneys retrieved by a transplant team are implanted at a single unit, often sequentially. This study analyzes the impact of a prolonged cold ischaemia time on the second transplanted kidney and the effects on short-term and long-term outcomes in all our DCD renal implants from 2002 to 2009. Cold ischaemia time was significantly longer with the second kidney (P = .04) as was delayed graft function (P = .02). Acute rejection was increased in the first transplanted kidney (P < .001). Five-year patient survival was comparable between groups, but 5-year graft survival was higher in the second transplanted group (P = .04). The results confirm that, provided recipient centers are willing to accept higher initial rates of delayed graft function, it is acceptable to transplant DCD grafts sequentially without jeopardizing long-term graft or recipient outcome.
authors.affiliation: Department of Organ Transplantation, St James’s University Hospital, Leeds, United Kingdom. Goldsmithpaul@hotmail.com
authors.forename: P J
authors.initials: PJ
authors.lastname: Goldsmith
authors.forename: D M
authors.initials: DM
authors.lastname: Ridgway
authors.forename: J K
authors.initials: JK
authors.lastname: Pine
authors.forename: C
authors.initials: C
authors.lastname: Ecuyer
authors.forename: R
authors.initials: R
authors.lastname: Baker
authors.forename: C
authors.initials: C
authors.lastname: Newstead
authors.forename: L
authors.initials: L
authors.lastname: Hostert
authors.forename: S G
authors.initials: SG
authors.lastname: Pollard
authors.forename: M
authors.initials: M
authors.lastname: Attia
authors.forename: K V
authors.initials: KV
authors.lastname: Menon
authors.forename: N
authors.initials: N
authors.lastname: Ahmad
mesh_terms: D000328:Adult; D003643:Death; D005260:Female; D006085:Graft Survival; D006801:Humans; D007511:Ischemia; D007668:Kidney / Q000098:blood supply*; D016030:Kidney Transplantation; D008297:Male; D012189:Retrospective Studies; D014019:Tissue Donors; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome