The national protocol for the uDCD program restricts the no flow period to <30 min and the total warm ischemia time (WIT) to <150 min. In situ kidney perfusion is realized by a double-balloon catheter or by a regional normothermic circulation (RNC). Kidneys are placed on a perfusion machine. Recipients must be less than 60 years old, listed for a 1st transplantation and non-immunized.

We present here the first results 5 years after the launch of this program.

Between 01/01/2007 and 01/10/2012, out of 641 detected potential uDCD donors 309 have been actually harvested, 229 harvested kidneys were discarded and 374 transplantations have been performed. Only, 48% of detected donors were converted to actual donors, 74% of actual donors were converted to utilized donors, so that 36% of detected donors were converted to utilized donors. Relative’s opposition rate was lower as compared to DBD (26 vs 32%).

The most predictive factors for procurement failure were the WIT and no flow delays with a strong interaction with old age donor. During this period, the use of RNC increased from 8 to 73% and the utilization rate of donors increased from 72 to 85%.

We observed a significant decrease in 3-month graft survival over time (95 to 86%) associated with a significant increase in the rate of primary non function. Risk of graft failure with uDCD appears 2 times higher than standard donor after brain death (DBD) and comparable to extended criteria DBD, even after adjustment for recipient age.

uDCD at the opposite of cDCD is an activity with heavy time constraints due to the conditions of unexpected cardiac arrest, mostly out-of-hospital setting. On the basis of our results, uDCD should be considered suboptimal, such as DBD with extended criteria.

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