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. 2014 May 22:15:83.
doi: 10.1186/1471-2369-15-83.

Do we need a different organ allocation system for kidney transplants using donors after circulatory death?

Shanka K Benaragama  1 , Teressa Tymkewycz, Biku J John, Andrew Davenport, Ben Lindsey, David Nicol, Jonathon Olsburgh, Martin Drage, Nizam Mamode, Francis Calder, John Taylor, Geoff Koffman, Nicos Kessaris, Mohamed Morsy, Roberto Cacciola, Carmelo Puliatti, Susana Fernadez-Diaz, Asim Syed, Nadey Hakim, Vassilios Papalois, Bimbi S Fernando
Affiliations

Do we need a different organ allocation system for kidney transplants using donors after circulatory death?

Shanka K Benaragama et al. BMC Nephrol. .

Abstract

Background: There is no national policy for allocation of kidneys from Donation after circulatory death (DCD) donors in the UK. Allocation is geographical and based on individual/regional centre policies. We have evaluated the short term outcomes of paired kidneys from DCD donors subject to this allocation policy.

Methods: Retrospective analysis of paired renal transplants from DCD's from 2002 to 2010 in London. Cold ischemia time (CIT), recipient risk factors, delayed graft function (DGF), 3 and 12 month creatinine) were compared.

Results: Complete data was available on 129 paired kidneys.115 pairs were transplanted in the same centre and 14 pairs transplanted in different centres. There was a significant increase in CIT in kidneys transplanted second when both kidneys were accepted by the same centre (15.5 ± 4.1 vs 20.5 ± 5.8 hrs p<0.0001 and at different centres (15.8 ± 5.3 vs. 25.2 ± 5.5 hrs p=0.0008). DGF rates were increased in the second implant following sequential transplantation (p=0.05).

Conclusions: Paired study sequential transplantation of kidneys from DCD donors results in a significant increase in CIT for the second kidney, with an increased risk of DGF. Sequential transplantation from a DCD donor should be avoided either by the availability of resources to undertake simultaneous procedures or the allocation of kidneys to 2 separate centres.

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