Session Time: 5:30pm-6:30pm
Presentation Time: 5:30pm-6:30pm
Location: Exhibit Hall E
The national protocol for the uDCD program restricts donor age < 55 y, no flow period < 30 min and total warm ischemia time (WIT) < 150 min. In situ kidney perfusion was performed either in hypothermia with a double-balloon catheter (ISP) or in normothermia (nRP). Machine Perfusion was mandatory. Only non-sensitized recipients awaiting a 1st transplant were eligible. 374 kidney transplants from 2007 to 2012) were analyzed. nRP was performed in 35% of the cases, mean WIT was 135 min and mean cold ischemia time (CIT) was 14 hours.
Risk factors analysis of primary non function (PNF, n=33) and graft failure (eGFR < 30ml/min or graft loss at 1 year, n=55) were performed by logistic regression.
PNF risk factor was paradoxically donor age less than 35 y [OR=4.24, p=0.007]. Sensibility analysis shown a center effect.
Graft failure risk factors (excluding PNF) were donor age and BMI, in situ organ perfusion modalities, ISP duration, HLA mismatch, CIT in univariate analysis (p < 0.2). No effect of donor age, no flow period, WIT or CIT were found in multivariate analysis. A significant risk of graft failure was associated with high donor BMI [OR=1.12, < 0.001] and ISP (compared to nRP) [OR=2, p= 0.05].
One and 3-year graft survival (without censuring deaths) were significantly different according to donor type: 87% and 79% for uDCD, 87% and 78% for DBD ECD and 94% and 89% for DBD-SCD. After adjustment on recipient age in a Cox model, a significant higher risk of failure at 1 year remained in uDCD recipients compared to optimal DBD [HR = 0.537].
In conclusion, uDCD kidneys represent an additional source of valuable transplants. The use of nRP decreased the graft failure rate [OR=2], probably through mechanisms close to those described in preconditioning experiments.
To cite this abstract in AMA style:Antoine C, Savoye E, Gaudez F, Cheisson G, Videcoq M, Barrou B, Steering National. Lessons Learned from the Clinical Use of Normothermic Regional Perfusion (nRP) in Uncontrolled Donation After Circulatory Death (DCD) [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/lessons-learned-from-the-clinical-use-of-normothermic-regional-perfusion-nrp-in-uncontrolled-donation-after-circulatory-death-dcd/. Accessed October 21, 2018.
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