Similar 5-Year Estimated Glomerular Filtration Rate Between Kidney Transplants From Uncontrolled and Controlled Donors After Circulatory Death-A Dutch Cohort Study.
Organ shortage persists despite a high rate of donation after circulatory death (DCD) in the Netherlands. The median waiting time for a deceased donor kidney in 2013 was 3.5 years. Most DCD kidneys are from controlled DCD (cDCD; Maastricht category III). Experience with uncontrolled donors after cardiac death (uDCD), that is, donors with an unexpected and irreversible cardiac arrest (Maastricht categories I and II), is increasing; and its effect on transplant outcomes needs evaluation.



We used the Dutch Organ Transplantation Registry to include recipients (≥18 years old) from all Dutch centers who received transplants from 2002 to 2012 with a first DCD kidney. We compared transplant outcome in uDCD (n = 97) and cDCD (n = 1441).



Primary nonfunction in uDCD was higher than in the cDCD (19.6% vs 9.6%, P < 0.001, respectively). Delayed graft function was also higher in uDCD than in cDCD, but not significantly (73.7% vs 63.3%, P = .074, respectively). If censored for primary nonfunction, estimated glomerular filtration rates after 1 year and 5 years were comparable between uDCD and cDCD (1 year: uDCD, 44.3 (23.4) mL/min/m and cDCD, 45.8 (24.1) mL/min/m; P = 0.621; 5 years: uDCD, 49.1 (25.6) mL/min/m and cDCD, 47.7 (21.7) mL/min/m; P = 0.686). The differences in primary nonfunction between kidneys from uDCD and cDCD were explained by differences in the first warm ischemic period, cold ischemic time, and donor age.



We conclude that uDCD kidneys have potential for excellent function and can constitute a valuable extension of the donor pool. However, further efforts are necessary to address the high rate of primary nonfunction.
1 Department of Nephrology, Academic Medical Center, the Netherlands. 2 Dutch Transplant Foundation, Leiden, the Netherlands. 3 Department of Surgery, Academic Medical Center, the Netherlands. 4 Department of Nephrology, Erasmus University Medical Center Rotterdam, the Netherlands. 5 Department of Nephrology, University Medical Center Utrecht, the Netherlands. 6 Department of Nephrology, Maastricht University Medical Center, the Netherlands. 7 Department of Nephrology, Radboud University Medical Center, the Netherlands. 8 Department of Nephrology, Leiden University Medical Center, the Netherlands. 9 Department of Nephrology, VU Medical Center, the Netherlands. 10 Department of Nephrology, University Medical Center Groningen, the Netherlands.
Hessel
H
Peters-Sengers
Jaap J
JJ
Homan van der Heide
Martin B A
MBA
Heemskerk
Ineke J M
IJM
Ten Berge
Fred C W
FCW
Ultee
Mirza M
MM
Idu
Michiel G H
MGH
Betjes
Arjan D
AD
van Zuilen
Maarten H L
MHL
Christiaans
Luuk H
LH
Hilbrands
Aiko P J
APJ
de Vries
Azam S
AS
Nurmohamed
Stefan P
SP
Berger
Frederike J
FJ
Bemelman
D000328:Adult; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000401:mortality*; D002423:Cause of Death; D046148:Donor Selection; D005260:Female; D005919:Glomerular Filtration Rate; D006085:Graft Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000503:physiopathology* / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D055031:Primary Graft Dysfunction / Q000209:etiology / Q000503:physiopathology; D012042:Registries; D012307:Risk Factors; D013997:Time Factors; D014019:Tissue Donors / Q000600:supply & distribution*; D016896:Treatment Outcome