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Uncontrolled Donors after Circulatory Death (uDCD) for Kidney Transplantation: Marginal or Optimal Donor?

C. Antoine, E. Savoye, D. Viglietti, G. Cheisson, B. Barrou, E. Morelon, M. Thuong, National Steering Committee Non Heart Beating Donors Group

Direction Medical et Scientifique, Biomedecine Agency, La Plaine Saint Denis, Seins Saint Denis, France
Department of Nephrology and Transplantation, Saint Louis Hospital, Paris, France
Department of Anesthesia and Critical Care, Bicetre Hospital, Kremlin Bicetre, Val de Marne, France
Department of Urology, University Hospital La Pitié, Paris, France
Department of Transplantation, Edouard Herriot Hospital Group, Lyon, Rhone, France

Meeting: 2013 American Transplant Congress

Abstract number: D1525

Related Abstracts
  • French Uncontrolled Donors after Circulatory Arrest (Udcd) Program for Kidney Transplantation: Procurement Procedure Efficiency and 3-Month Survival Results
  • Lessons Learned from the Clinical Use of Normothermic Regional Perfusion (nRP) in Uncontrolled Donation After Circulatory Death (DCD)

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 1st 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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To cite this abstract in AMA style:

Antoine C, Savoye E, Viglietti D, Cheisson G, Barrou B, Morelon E, Thuong M. Uncontrolled Donors after Circulatory Death (uDCD) for Kidney Transplantation: Marginal or Optimal Donor? [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/uncontrolled-donors-after-circulatory-death-udcd-for-kidney-transplantation-marginal-or-optimal-donor/. Accessed January 25, 2021.

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