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. Eligible recipients must be less than 60 years old, listed for a 1st transplantation and non-immunized.

The aim of this study was to compare 1-year graft function and survival rates according to three types of donors: uDCD donors, donors after brain death (DBD) with non-extended criteria (DBD-NECD) and those with extended criteria (DBD-ECD), only among eligible patients for the uNHBD program.

Between 01/01/2007 and 31/12/2009, 160 “eligible” recipients were transplanted with uDCD, 894 with DBD-NECD and 255 with DBD-ECD (mean follow up of 328 days with an end-point at March 1^st 2011).

uDCD transplanted patients had a shorter waiting time before transplantation, were more often of the B blood group, received more graft from male donors and right kidney, had shorter CIT and poor HLA matching.

Primary non function incidence was comparable between the 3 groups. Delayed graft function was significantly more frequent in case of uDCD [76% vs. 36% (NECD) and 45% (ECD)]. We observed a difference in 1-year renal clearance only between uDCD patients and NECD patients (47.8 vs. 56.1 ml/min). 1-year graft survival was significantly different according to donor type (p=0.012) with 90.7% for uDCD patients, 95.3% for NECD patients and 91.1% for ECD patients. After adjustment, a significant increased risk of failure remains in uDCD recipients compared to NECD [RR of NECD vs. NHBD = 0.507].

uDCD kidneys represent a valuable additional source of organs for transplantation but 1-year survival and renal function appear more comparable to renal transplantation with ECD than those with optimal donors.

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