ORIGINAL ARTICLE   Free access

Minerva Urology and Nephrology 2023 June;75(3):329-42

DOI: 10.23736/S2724-6051.23.05098-X

Copyright © 2023 EDIZIONI MINERVA MEDICA

language: English

Outcomes of kidney transplantation from uncontrolled donors after circulatory death vs. expanded-criteria or standard-criteria donors after brain death at an Italian Academic Center: a prospective observational study

Riccardo CAMPI ^{1, 2} ✉, Alessio PECORARO ¹, Francesco SESSA ¹, Graziano VIGNOLINI ¹, Leonardo CAROTI ³, Chiara LAZZERI ⁴, Adriano PERIS ⁴, Sergio SERNI ^{1, 2}, Vincenzo LI MARZI ¹ University of Florence Kidney Transplantation Working Group 

¹ Unit of Urological Robotic Surgery and Renal Transplantation, Careggi University Hospital, University of Florence, Florence, Italy; ² Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; ³ Unit of Nephrology, Dialysis and Transplant, Careggi University Hospital, Florence, Italy; ⁴ Regional and Intensive Care Unit, ECMO Referral Center, Careggi University Hospital, Florence, Italy

BACKGROUND: The use of kidneys from “expanded criteria” donors after brain death (ECD) and uncontrolled donors after circulatory death (uDCD) has been warranted to increase the pool of donors for kidney transplantation (KT). However, there is lack of evidence on the feasibility and safety of KT from such donors in the Italian setting.
METHODS: We queried our prospectively KT database to select patients undergoing KT from deceased donors (uDCDs, ECDs, and standard-criteria donors [SCD] after brain death) from January 2017 to December 2020, comparing the perioperative and mid-term functional outcomes.
RESULTS: Overall, 172 KTs were included. The donor’s profile was different among the study groups, while recipients’ characteristics were similar expect for median age. Grafts from uDCDs and ECDs had longer median cold ischemia times as compared to grafts from SCDs. The proportion of patients experiencing DGF, the median hospitalization, as well as the overall and major complications rate, were significantly higher among recipients from uDCDs. The proportion of patients needing dialysis at last follow-up was significantly higher among recipients from uDCDs (33.3% vs. 8.5% vs. 5.4%, P<0.001). However, the median eGFR at the last follow-up was lower for recipients from ECDs compared to those from uDCDs and SCDs, respectively (P<0.001).
CONCLUSIONS: While “marginal” donors represent a relevant source of organs, KTs from uDCDs carry higher risks of major surgical complications, DGF, and worse graft survival as compared to KT from both ECDs and SCDs. As such, the use of grafts from uDCDs should be carefully assessed balancing the potential benefits with the risk of primary no function and the subsequent immunological sensitization.

KEY WORDS: Kidney transplantation; Robotic surgical procedures; Kidney transplantation; Tissue donors