Elsevier

Transplantation Proceedings

Volume 51, Issue 9, November 2019, Pages 2865-2867
Transplantation Proceedings

42nd Congress of the Italian Transplantation Society
Organ procurement and allocation
Kidney Transplantation From Circulatory Death Donors: Monocentric Experience

https://doi.org/10.1016/j.transproceed.2019.07.012Get rights and content

Highlights

  • DCD kidney transplantation is a valid resource to expand the pool of deceased donors.

  • Clinical, histological, and perfusion parameters are essential in graft evaluation.

  • Double kidney transplantation is possible in the DCD settings.

  • Preliminary results of our center confirm satisfactory outcomes.

Abstract

Background

Donation after circulatory death (DCD) is an accepted strategy to widen organ procurement worldwide. Authorized centers in Italy are spreading, increasing kidney transplantation (KTX) from DCD donors (40 in 2017 vs 24 in 2016). In this study, we describe DCD KTX activity at the University of Modena and Reggio Emilia (Modena, Italy) since its beginning in November 2017.

Methods

We retrospectively studied DCD KTX performed in our center from November 2017 to June 2018. We considered donor characteristics (age, sex, cause of death) and recipient clinical data (length of hospital stay, serum creatinine, estimated glomerular filtration rate, delayed graft function [DGF]), primary nonfunction [PNF], HLA match). All the grafts underwent in situ normothermic (ExtraCorporeal Membrane Oxygenation-ECMO) and ex situ hypothermic oxygenated perfusion (HOPE) with Kidney Assist machines. We monitored ex situ perfusion solution biochemical (lactate dehydrogenase [LDH] and lactate) and dynamic (resistance and flow) parameters. A kidney biopsy was performed for allocation strategy according to Karpinski score.

Results

We performed 6 kidney transplants (3 single and 3 double); the mean recipient (57.5 ± 4.9) and donor age (57.3 ± 7.5) were similar. Mean ECMO duration was 3 h 27 ± 57 min, HOPE was 4 h 47 min ± 119 min, lactate sample values (collected every 15 minutes from the beginning of perfusion) were always lower than1.6 mmol/L, and LDH maximum value was 400 UI/L. Median cold ischemia time was 11 h 18 min. Mean Karpinski score was 3.6; mean HLA match 1.7.We experienced 1 DGF (16.6%), no PNF, with a mean hospital stay of 14.6 days, mean creatinine at hospital discharge 2 ± 1.04 mg/dL), and mean eGFR 53.8 ±27.3 mL/min); at 1 month, mean creatinine and eGFR were 2 ± 1.34 mg/dL and 59.8 ± 24.5 mL/min, respectively.

Conclusions

DCD is a promising resource for increasing organ donation. The Emilia Romagna regional organization allowed short ischemia times, with solid KTX outcomes, supporting further development of this program.

Section snippets

Materials and Methods

We describe DCD KTX activity the University Hospital of Modena from the implementation of the program in November 2017 to June 2018.

According to our protocol, every graft underwent in situ normothermic regional perfusion (ECMO), followed by ex situ hypothermic oxygenated perfusion (HOPE) by Kidney Assist, to ensure optimal graft preservation and evaluation. A kidney biopsy was performed for allocation strategy based on the Karpinski score (Single KTX up to 4-4, discarded over 6-6, double for

Results

We performed a total of 6 KTX (3 single and 3 double) from Maastricht category III DCD donors (Table 1). Time from asystole to ECMO start was 20 minutes. ECMO was established postasystole via aortic and caval cannulation and maintained for an average of 3 h 27 minutes (range, 2 h 51 min-4 h 44 min). The mean duration of HOPE was 4 h 47 min (range, 2 h 52 min-7 h 47 min), perfusion was maintained at an inferior systolic pressure of 120 mm Hg, average flow was 130 mL/min, and mean resistance

Discussion

The preliminary results of DCD KTX program of our unit confirm satisfactory outcomes in terms of kidney function, DGF, and PNF. A null discard rate in the perfused organs suggests effective donor selection criteria and an optimal procurement organization. This was also confirmed by low ischemia times regardless of donation site.

Perfusion fluid biochemical and dynamic values did not differ substantially from case to case, placing within or close to the normal range, thus not influencing clinical

Conclusions

The DCD program is a promising resource for increasing organ donations. ECMO and HOPE, combined with clinical and histological data, allowed adequate organ evaluation and recovery. In our experience, DCD KTX outcomes are satisfactory and encourage further development of the program.

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