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.

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