title: Successful transplantation of kidneys from elderly circulatory death donors by using microscopic and macroscopic characteristics to guide single or dual implantation.
abstract: Most kidneys from potential elderly circulatory death (DCD) donors are declined. We report single center outcomes for kidneys transplanted from DCD donors over 70 years old, using preimplantation biopsy Remuzzi grading to inform implantation as single or dual transplants. Between 2009 and 2012, 43 single transplants and 12 dual transplants were performed from elderly DCD donors. Remuzzi scores were higher for dual than single implants (4.4 vs. 3.4, p < 0.001), indicating more severe baseline injury. Donor and recipient characteristics for both groups were otherwise similar. Early graft loss from renal vein thrombosis occurred in two singly implanted kidneys, and in one dual-implanted kidney; its pair continued to function satisfactorily. Death-censored graft survival at 3 years was comparable for the two groups (single 94%; dual 100%), as was 1 year eGFR. Delayed graft function occurred less frequently in the dual-implant group (25% vs. 65%, p = 0.010). Using this approach, we performed proportionally more kidney transplants from elderly DCD donors (23.4%) than the rest of the United Kingdom (7.3%, p < 0.001), with graft outcomes comparable to those achieved nationally for all deceased-donor kidney transplants. Preimplantation biopsy analysis is associated with acceptable transplant outcomes for elderly DCD kidneys and may increase transplant numbers from an underutilized donor pool.
authors.affiliation: University Department of Surgery, Addenbrooke's Hospital, Cambridge, UK.
authors.forename: D H
authors.initials: DH
authors.lastname: Mallon
authors.affiliation: University Department of Surgery, Addenbrooke's Hospital, Cambridge, UK.
authors.forename: G E
authors.initials: GE
authors.lastname: Riddiough
authors.affiliation: University Department of Surgery, Addenbrooke's Hospital, Cambridge, UK.
authors.forename: D M
authors.initials: DM
authors.lastname: Summers
authors.affiliation: University Department of Surgery, Addenbrooke's Hospital, Cambridge, UK.
authors.forename: A J
authors.initials: AJ
authors.lastname: Butler
authors.affiliation: University Department of Surgery, Addenbrooke's Hospital, Cambridge, UK.
authors.forename: C J
authors.initials: CJ
authors.lastname: Callaghan
authors.affiliation: NHS Blood and Transplant, Bristol, UK.
authors.forename: L L
authors.initials: LL
authors.lastname: Bradbury
authors.affiliation: Department of Histopathology, Addenbrooke's Hospital, Cambridge, UK.
authors.forename: V
authors.initials: V
authors.lastname: Bardsley
authors.affiliation: Department of Histopathology, Addenbrooke's Hospital, Cambridge, UK.
authors.forename: V
authors.initials: V
authors.lastname: Broecker
authors.affiliation: University Department of Surgery, Addenbrooke's Hospital, Cambridge, UK.
authors.forename: K
authors.initials: K
authors.lastname: Saeb-Parsy
authors.affiliation: Department of Renal Medicine, Addenbrooke's Hospital, Cambridge, UK.
authors.forename: N
authors.initials: N
authors.lastname: Torpey
authors.affiliation: University Department of Surgery, Addenbrooke's Hospital, Cambridge, UK.
authors.forename: J A
authors.initials: JA
authors.lastname: Bradley
authors.affiliation: University Department of Surgery, Addenbrooke's Hospital, Cambridge, UK.
authors.forename: G J
authors.initials: GJ
authors.lastname: Pettigrew
mesh_terms: D000367:Age Factors; D000368:Aged; D001707:Biopsy, Needle; D002318:Cardiovascular Diseases / Q000401:mortality*; D015331:Cohort Studies; D051799:Delayed Graft Function / Q000453:epidemiology* / Q000473:pathology; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology; D006085:Graft Survival; D006801:Humans; D007150:Immunohistochemistry; D007430:Intraoperative Care / Q000379:methods; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods*; D008297:Male; D011379:Prognosis; D012042:Registries; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D015996:Survival Rate; D014019:Tissue Donors / Q000706:statistics & numerical data*; D009927:Tissue and Organ Procurement / Q000379:methods*; D066027:Transplant Recipients / Q000706:statistics & numerical data; D016896:Treatment Outcome; D006113:United Kingdom
keywords: Donors and donation: donation after circulatory death (DCD); organ allocation; protocol biopsy