Lucas Device Assisted Uncontrolled Dcd Kidney Transplantation – A Feasible but Underutilized Option in the United States
Renal Transplant, Charleston Area Medical Center, Charleston, WV
Meeting: 2022 American Transplant Congress
Abstract number: 721
Keywords: Donors, marginal, Donors, non-heart-beating, Kidney transplantation, Warm ischemia
Topic: Clinical Science » Kidney » 32 - Kidney Deceased Donor Selection
Session Information
Session Name: Kidney Deceased Donor Selection
Session Type: Poster Abstract
Date: Saturday, June 4, 2022
Session Time: 5:30pm-7:00pm
Presentation Time: 5:30pm-7:00pm
Location: Hynes Halls C & D
*Purpose: Uncontrolled DCD (uDCD) procurement involves either normo-thermic or hypothermic regional perfusion to reduce ischemic injury. We report a series of successful kidney transplant utilizing kidneys from three uDCD with >100min WIT without normo-thermic or hypothermic regional perfusion.
*Methods: Donor 1: A 34-year-old male, height 172.7 cm, weight 94.5 kg, BMI 31.6 kg/m2 presented to the hospital with acute gastrointestinal bleeding. No prior medical history. WIT was 167 min.Donor 2: A 25-year-old female, height 162.5 cm, weight 107.4 kg, BMI 40 kg/m2 presented to the hospital as a trauma victim – motor vehicle accident. Underwent emergency laparotomy with splenectomy and control of bleeding from liver. She then succumbed and was an uDCD with WIT of 122min.
Donor 3: 48-year-old female,height 5 ft 6 in, weight 56.9 kilos, BMI 20 kg/m2 who died from self-inflicted gunshot wound to the head. uDCD with WIT 107min.After procurement all kidneys were placed on a hypothermic pulsatile perfusion pump. All kidneys also had procurement biopsies performed to rule out cortical necrosis.
*Results: Recipient characteristics are shown in table below. All patients were given induction immunosuppression with thymoglobulin (4.5mg/kg) and steroids. Maintenance was with Tacrolimus, Mycophenolate Mofetil and prednisone. 1 out of 4 had delayed graft function and needed dialysis. 3 out of 4 patients had indication biopsy for elevated creatinine. One had borderline rejection that was treated with steroid pulse and 1 had BK virus nephropathy – grade 2 and was treated with lowering of immunosuppression and IVIg. To minimize nephrotoxicity from CNI 3 out of the 4 were transitioned to Belatacept. The serum creatinine trends are shown in Fig 1.
| Recipient 1a | Recipient 1b | Recipient 2 | Recipient 3 | |
| Age | 51 | 68 | 50 | 67 |
| Gender | F | M | F | M |
| BMI (Kg/m2) | 25.45 | 33.8 | 33.0 | 40.12 |
| Ethnicity | Caucasian | Caucasian | Caucasian | Caucasian |
| Blood type | A | A | A | O |
| Cause of CKD | DM, HTN | DM, HTN | PCKD | DM, HTN |
| HLA mismatch | 2,2,2 | 0,2,2 | 2,2,2 | 2,2,2 |
| CPRA | 0 | 0 | 0 | 0 |
| CMV Match (D/R) | +/+ | +/- | +/- | +/+ |
| EBV Match (D/R) | -/+ | -/+ | +/+ | +/- |
| Years on Dialysis | 0 | 1 | 0.5 | 1.3 |
| Sequence number on waitlist | 6884 | 7784 | 7483 | 16325 |
| Length of stay (Days) | 5 | 5 | 4 | 16 |
*Conclusions: Uncontrolled DCD kidneys are viable source for transplantation. Utilization of extrinsic mechanical chest compression during the uncontrolled DCD with prolonged warm ischemia time may improve kidney perfusion and translate into kidney utilization for transplantation.
To cite this abstract in AMA style:
Nagaraju S, Vaishnav S, Savilla R, Moore M, Africa JB. Lucas Device Assisted Uncontrolled Dcd Kidney Transplantation – A Feasible but Underutilized Option in the United States [abstract]. Am J Transplant. 2022; 22 (suppl 3). https://atcmeetingabstracts.com/abstract/lucas-device-assisted-uncontrolled-dcd-kidney-transplantation-a-feasible-but-underutilized-option-in-the-united-states/. Accessed November 21, 2024.« Back to 2022 American Transplant Congress