Corinne Antoine1, Emilie Savoye1, François Gaudez2, Gaelle Cheisson3, Lionel Badet4, Michel Videcoq5, Camille Legeai1, Olivier Bastien1, Benoit Barrou6. 1. Agence de la biomédecine, Direction Prélèvement Greffe Organes-Tissus, Saint-Denis La Plaine, France. 2. CHU Saint Louis (APHP), Urologie, Paris, France. 3. Hôpital Bicêtre, Anesthésie Réanimation, Le Kremlin-Bicêtre, France. 4. Hospices Civils de Lyon Hôpital Edouard Herriot, chirurgie de la transplantation pav V et immuno clinique et TX pav p, Lyon, France. 5. CHU Nantes, Anesthésie Réanimation, Nantes, France. 6. Hôpital de la Pitié Salpêtrière, Urologie, Paris, France.
Abstract
BACKGROUND: The French uncontrolled donors after circulatory death (DCD) protocol restricts donor age to <55 years, no-flow time to <30 minutes, and functional warm ischemia time to <150 minutes. In situ kidney perfusion can be performed at either 4°C (in situ cooling [ISC]) or 33-36°C (normothermic regional perfusion [NRP]). Hypothermic machine perfusion is systematically used. Only nonimmunized first transplant recipients were eligible. To improve the management of uncontrolled DCD, we tried to identify factors predictive of outcome. METHODS: We identified all kidney transplants from uncontrolled DCD between 2007 and 2014 from the French Transplant Registry. Risk factors for primary nonfunction (PNF; n = 37) and poor renal function (estimated glomerular filtration rate < 30 mL/min or graft loss at 1 y, n = 66) were analyzed by using a multivariate logistic model. RESULTS: This study analyzed 499 kidney transplantations, 50% of which were performed with NRP. Mean functional warm ischemia time was 135 minutes. Mean cold ischemia time was 14 hours. The principal PNF risk factor was young donor age (odds ratio [OR] = 0.95; P = 0.002). A sensitivity analysis showed a higher risk of PNF with ISC than with NRP (OR = 4.5; P = 0.015). Risk factors for poor renal function were donor body mass index (OR = 1.2; P < 0.001) and ISC versus NRP. Univariate analysis of uncontrolled DCD-specific risk factors showed no-flow time, functional warm time, and cold ischemia time did not affect the risk of PNF or poor renal function. CONCLUSIONS: Uncontrolled DCD kidneys are an additional source of valuable transplants. NRP appears to decrease graft failure by restoring oxygenated blood as the first step of preconditioning.
BACKGROUND: The French uncontrolled donors after circulatory death (DCD) protocol restricts donor age to <55 years, no-flow time to <30 minutes, and functional warm ischemia time to <150 minutes. In situ kidney perfusion can be performed at either 4°C (in situ cooling [ISC]) or 33-36°C (normothermic regional perfusion [NRP]). Hypothermic machine perfusion is systematically used. Only nonimmunized first transplant recipients were eligible. To improve the management of uncontrolled DCD, we tried to identify factors predictive of outcome. METHODS: We identified all kidney transplants from uncontrolled DCD between 2007 and 2014 from the French Transplant Registry. Risk factors for primary nonfunction (PNF; n = 37) and poor renal function (estimated glomerular filtration rate < 30 mL/min or graft loss at 1 y, n = 66) were analyzed by using a multivariate logistic model. RESULTS: This study analyzed 499 kidney transplantations, 50% of which were performed with NRP. Mean functional warm ischemia time was 135 minutes. Mean cold ischemia time was 14 hours. The principal PNF risk factor was young donor age (odds ratio [OR] = 0.95; P = 0.002). A sensitivity analysis showed a higher risk of PNF with ISC than with NRP (OR = 4.5; P = 0.015). Risk factors for poor renal function were donor body mass index (OR = 1.2; P < 0.001) and ISC versus NRP. Univariate analysis of uncontrolled DCD-specific risk factors showed no-flow time, functional warm time, and cold ischemia time did not affect the risk of PNF or poor renal function. CONCLUSIONS: Uncontrolled DCD kidneys are an additional source of valuable transplants. NRP appears to decrease graft failure by restoring oxygenated blood as the first step of preconditioning.
Authors: Fiona Hunt; Chris J C Johnston; Lesley Coutts; Ahmed E Sherif; Lynsey Farwell; Ben M Stutchfield; Avi Sewpaul; Andrew Sutherland; Benoy I Babu; Ian S Currie; Gabriel C Oniscu Journal: Transpl Int Date: 2022-06-03 Impact factor: 3.842
Authors: Emad Alamouti-Fard; Pankaj Garg; Ishaq J Wadiwala; John H Yazji; Mohammad Alomari; Md Walid Akram Hussain; Mohamed S Elawady; Samuel Jacob Journal: Cureus Date: 2022-06-29
Authors: Alberto Artiles Medina; Francisco Javier Burgos Revilla; Marta Álvarez Nadal; Alfonso Muriel García; Noelia Álvarez Díaz; Victoria Gómez Dos Santos Journal: Transl Androl Urol Date: 2021-08
Authors: Thomas Prudhomme; John F Mulvey; Liam A J Young; Benoit Mesnard; Maria Letizia Lo Faro; Ann Etohan Ogbemudia; Fungai Dengu; Peter J Friend; Rutger Ploeg; James P Hunter; Julien Branchereau Journal: Int J Mol Sci Date: 2021-05-13 Impact factor: 5.923
Authors: Patricia Ramirez; David Vázquez; Gabriel Rodríguez; Juan José Rubio; Marina Pérez; Jose Maria Portolés; Joaquín Carballido Journal: Transplant Direct Date: 2021-07-16