title: Transplantation of kidneys from uncontrolled donation after circulatory determination of death: comparison with brain death donors with or without extended criteria and impact of normothermic regional perfusion.
abstract: The aim of this study was to compare the outcomes of kidney transplants from uncontrolled DCD (uDCD) with kidney transplants from extended (ECD) and standard criteria donors (SCD). In this multicenter study, we included recipients from uDCD (n = 50), and from ECD (n = 57) and SCD (n = 102) who could be eligible for a uDCD program. We compared patient and graft survival, and kidney function between groups. To address the impact of preservation procedures in uDCD, we compared in situ cold perfusion (ICP) with normothermic regional perfusion (NRP). Patient and graft survival rates were similar between the uDCD and ECD groups, but were lower than the SCD group (P < 0.01). Although delayed graft function (DGF) was more frequent in the uDCD group (66%) than in the ECD (40%) and SCD (27%) groups (P = 0.08 and P < 0.001), graft function was comparable between the uDCD and ECD groups at 3 months onwards post-transplantation. The use of NRP in the uDCD group (n = 19) was associated with a lower risk of DGF, and with a better graft function at 2 years post-transplantation, compared to ICP-uDCD (n = 31) and ECD. In conclusion, the use of uDCD kidneys was associated with post-transplantation results comparable to those of ECD kidneys. NRP preservation may improve the results of uDCD transplantation.
authors.affiliation: Néphrologie-Dialyse-Transplantation, CHU Angers, Angers Cedex 9, France.|LUNAM Université, Angers, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Demiselle
authors.affiliation: Néphrologie-Dialyse-Transplantation, CHU Angers, Angers Cedex 9, France.|LUNAM Université, Angers, France.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Augusto
authors.affiliation: Coordination des prélèvements d'organe et de tissus, Hôtel Dieu, Nantes Cedex 1, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Videcoq
authors.affiliation: SAMU, Hôtel Dieu, Nantes Cedex 1, France.
authors.forename: Estelle
authors.initials: E
authors.lastname: Legeard
authors.affiliation: Coordination Hospitalière, CHU Angers, Angers Cedex 9, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Dubé
authors.affiliation: SAMU, CHU Angers, Angers Cedex 9, France.
authors.forename: François
authors.initials: F
authors.lastname: Templier
authors.affiliation: Anatomopathologie, Hôtel Dieu, Nantes Cedex 1, France.
authors.forename: Karine
authors.initials: K
authors.lastname: Renaudin
authors.affiliation: Néphrologie-Dialyse-Transplantation, CHU Angers, Angers Cedex 9, France.|LUNAM Université, Angers, France.
authors.forename: Johnny
authors.initials: J
authors.lastname: Sayegh
authors.affiliation: ITUN (Institut de Transplantation, Urologie et Néphrologie), Hôtel Dieu, Nantes Cedex, France.
authors.forename: Georges
authors.initials: G
authors.lastname: Karam
authors.affiliation: ITUN (Institut de Transplantation, Urologie et Néphrologie), Hôtel Dieu, Nantes Cedex, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Blancho
authors.affiliation: ITUN (Institut de Transplantation, Urologie et Néphrologie), Hôtel Dieu, Nantes Cedex, France.
authors.forename: Jacques
authors.initials: J
authors.lastname: Dantal
mesh_terms: D000328:Adult; D000368:Aged; D001926:Brain Death; D003643:Death; D051799:Delayed Graft Function; D005112:Extracorporeal Circulation; D005260:Female; D005602:France; D005919:Glomerular Filtration Rate; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007165:Immunosuppression Therapy; D016030:Kidney Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009926:Organ Preservation / Q000379:methods; D010477:Perfusion; D011446:Prospective Studies; D013997:Time Factors; D014019:Tissue Donors; D016896:Treatment Outcome
keywords: kidney transplantation; normothermic regional preservation; outcome; uncontrolled cardiac death donation