Kidney damage during organ recovery in donation after circulatory death donors: data from UK National Transplant Database.
During the last 10 years, kidneys recovered/transplanted from donors after circulatory death (DCD) have significantly increased. To optimize their use, there has been an urgent need to minimize both warm and cold ischemia, which often necessitates more rapid removal. To compare the rates of kidney injury during procurement from DCD and donors after brain death (DBD) organ donors. A total of 13 260 kidney procurements were performed in the United Kingdom over a 10-year period (2000-2010). Injuries occurred in 903 procedures (7.1%). Twelve thousand three hundred seventy-two (93.3%) kidneys were recovered from DBD donors and 888 (6.7%) from DCD donors. The rates of kidney injury were significantly higher when recovered from DCD donors (11.4% vs. 6.8%, p < 0.001). Capsular, ureteric and vascular injuries were all significantly more frequent (p = 0.002, p < 0.001 and p = 0.017, respectively). Discard because of injury was more common after DCD donation (p = 0.002). Multivariate analysis demonstrated procurement injuries were significantly associated with DCD donors (p = 0.035) and increased donor age (<0.001) and donor body mass index (BMI; 0.001), donor male gender (p = 0.001) and no liver donation (0.009). We conclude that procurement from DCD donors leads to higher rates of injury to the kidney and are more likely to be discarded.
HPB and Transplant Surgery, Freeman Hospital, Newcastle Upon Tyne, UK. f.ausania@googlemail.com
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D000293:Adolescent; D000328:Adult; D001926:Brain Death; D002102:Cadaver; D002648:Child; D002675:Child, Preschool; D016757:Death, Sudden, Cardiac; D051799:Delayed Graft Function; D005260:Female; D006085:Graft Survival; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007668:Kidney / Q000293:injuries*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D009926:Organ Preservation; D012189:Retrospective Studies; D015996:Survival Rate; D014019:Tissue Donors / Q000600:supply & distribution*; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome; D006113:United Kingdom; D055815:Young Adult