Kidney donation after circulatory death in a country with a high number of brain dead donors: 10-year experience in Belgium.
Worldwide shortage of standard brain dead donors (DBD) has revived the use of kidneys donated after circulatory death (DCD). We reviewed the Belgian DCD kidney transplant (KT) experience since its reintroduction in 2000. Risk factors for delayed graft function (DGF) were identified using multivariate analysis. Five-year patient/graft survival was assessed using Kaplan-Meier curves. The evolution of the kidney donor type and the impact of DCDs on the total KT activity in Belgium were compared with the Netherlands. Between 2000 and 2009, 287 DCD KT were performed. Primary nonfunction occurred in 1% and DGF in 31%. Five-year patient and death-censored graft survival were 93% and 95%, respectively. In multivariate analysis, cold storage (versus machine perfusion), cold ischemic time, and histidine-tryptophan-ketoglutarate solution were independent risk factors for the development of DGF. Despite an increased number of DCD donations and transplantations, the total number of deceased KT did not increase significantly. This could suggest a shift from DBDs to DCDs. To increase KT activity, Belgium should further expand controlled DCD programs while simultaneously improve the identification of all potential DBDs and avoid their referral for donation as DCDs before brain death occurs. Furthermore, living donation remains underused.
Department of Abdominal Transplant Surgery, University Hospitals Leuven, KULeuven, Leuven, Belgium. ina.jochmans@med.kuleuven.be
Ina
I
Jochmans
Tom
T
Darius
Dirk
D
Kuypers
Diethard
D
Monbaliu
Eric
E
Goffin
Michel
M
Mourad
Hieu
H
Ledinh
Laurent
L
Weekers
Patrick
P
Peeters
Caren
C
Randon
Jean-Louis
JL
Bosmans
Geert
G
Roeyen
Daniel
D
Abramowicz
Anh-Dung
AD
Hoang
Luc
L
De Pauw
Axel
A
Rahmel
Jean-Paul
JP
Squifflet
Jacques
J
Pirenne
D000328:Adult; D001530:Belgium; D001926:Brain Death; D050377:Cold Ischemia; D003643:Death; D051799:Delayed Graft Function / Q000209:etiology*; D005260:Female; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009927:Tissue and Organ Procurement / Q000379:methods*