title: Preliminary results of transplantation with kidneys donated after cardiocirculatory determination of death: a French single-centre experience.
abstract: BACKGROUND
  Donation after circulatory determination of death (DCDD), formerly non-heart-beating donation and donation after cardiac death, has been re-introduced into clinical practice in France since June 2006 as a potential solution to organ shortage, but this kidney transplantation programme is not popular yet, mainly because of logistical concerns and uncertainty about the long-term warm ischaemia impact on transplanted kidneys.
  
  
  METHODS
  Our institution started the DCDD programme in January 2007, following the national 'BioMedicine Agency' protocol. We only considered uncontrolled donors with an initial no-flow period (i.e. delay between collapse and external cardiac massage start) <30 min. A 5-min stand-off period was observed before declaring the death and performing in situ cold perfusion, and since January 2010, normothermic subdiaphragmatic extracorporeal membrane oxygenation. All kidneys were machine-perfused using the hypothermic pulsatile preservation system before transplantation. Morphologic assessment and perfusion indexes were used to assess the suitability for transplantation.
  
  
  RESULTS
  From January 2007 to December 2010, our team performed 58 kidney transplantations from uncontrolled Maastricht Category I and II donors. Mean recipient age was 47 ± 9 years. Male/female ratio was 45/13. Mean waiting time on transplantation registry was 30 months (4-180). Mean cold ischaemia time was 13 h 40 min (7-18) and pulsatile perfusion time 8 h (1-16). We had three cases (5%) of primary non-function (PNF) and 95% of delayed graft function. There was no increase in biopsy-proven acute rejection incidence (12.7%). Patient and graft survivals were 98 and 91.4%, respectively, at 1 year and 98 and 88%, respectively, at last follow-up. Estimated glomerular filtration rate ( Modification of Diet in Renal Disease formula) was 48 ± 16 mL/min/1.73 m(2) at 1 year and 48 ± 15 mL/min/1.73 m(2) at the last follow-up.
  
  
  CONCLUSIONS
  DCDD kidneys are a valuable additional source of organs for transplantation. Our results show encouraging outcomes, which give rise to further interest in this donor pool. Respecting the national protocol is crucial to prevent PNF and deleterious warm ischaemia effect on transplanted kidney.
authors.affiliation: Nephrology and Transplantation, Saint Louis Hospital, Assistance Publique - Hôpitaux de Paris. imad.abboud@sls.aphp.fr
authors.forename: Imad
authors.initials: I
authors.lastname: Abboud
authors.forename: Denis
authors.initials: D
authors.lastname: Viglietti
authors.forename: Corinne
authors.initials: C
authors.lastname: Antoine
authors.forename: François
authors.initials: F
authors.lastname: Gaudez
authors.forename: Paul
authors.initials: P
authors.lastname: Meria
authors.forename: Edouard
authors.initials: E
authors.lastname: Tariel
authors.forename: Pierre
authors.initials: P
authors.lastname: Mongiat-Artus
authors.forename: François
authors.initials: F
authors.lastname: Desgranchamps
authors.forename: France
authors.initials: F
authors.lastname: Roussin
authors.forename: Fabienne
authors.initials: F
authors.lastname: Fieux
authors.forename: Laurent
authors.initials: L
authors.lastname: Jacob
authors.forename: Christine
authors.initials: C
authors.lastname: Randoux
authors.forename: Catherine
authors.initials: C
authors.lastname: Michel
authors.forename: Martin
authors.initials: M
authors.lastname: Flamant
authors.forename: Carmen
authors.initials: C
authors.lastname: Lefaucheur
authors.forename: Evangeline
authors.initials: E
authors.lastname: Pillebout
authors.forename: Tomas
authors.initials: T
authors.lastname: Serrato
authors.forename: Marie-Noelle
authors.initials: MN
authors.lastname: Peraldi
authors.forename: Denis
authors.initials: D
authors.lastname: Glotz
mesh_terms: D000293:Adolescent; D000328:Adult; D003326:Coronary Circulation / Q000502:physiology*; D003643:Death; D046148:Donor Selection; D005260:Female; D005602:France; D005919:Glomerular Filtration Rate; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D014019:Tissue Donors / Q000600:supply & distribution*; D009927:Tissue and Organ Procurement; D055815:Young Adult