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. 2020 Jan;104(1):130-136.
doi: 10.1097/TP.0000000000002753.

Kidney Transplant From Uncontrolled Donation After Circulatory Death: Contribution of Normothermic Regional Perfusion

Corinne Antoine  1 , Emilie Savoye  1 , François Gaudez  2 , Gaelle Cheisson  3 , Lionel Badet  4 , Michel Videcoq  5 , Camille Legeai  1 , Olivier Bastien  1 , Benoit Barrou  6 ; National Steering Committee of Donation After Circulatory Death
Affiliations

Kidney Transplant From Uncontrolled Donation After Circulatory Death: Contribution of Normothermic Regional Perfusion

Corinne Antoine et al. Transplantation. 2020 Jan.

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.

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References

    1. Antoine C, Mourey F, Prada-Bordenave E; Steering committee on DCD program. How France launched its donation after cardiac death program. Ann Fr Anesth Reanim. 2014; 33:138–143
    1. Agence de la biomédecine. Agence de la biomédecine - Le rapport annuel médical et scientifique 2015 [Internet]. Available at https://www.agence-biomedecine.fr/annexes/bilan2015/accueil.html. Accessed April 27, 2017
    1. Port FK, Bragg-Gresham JL, Metzger RA, et al. Donor characteristics associated with reduced graft survival: an approach to expanding the pool of kidney donors. Transplantation. 2002; 74:1281–1286
    1. del Río F, Andrés A, Padilla M, et al. Kidney transplantation from donors after uncontrolled circulatory death: the Spanish experience. Kidney Int. 2019; 95:420–428
    1. Valero R, Cabrer C, Oppenheimer F, et al. Normothermic recirculation reduces primary graft dysfunction of kidneys obtained from non-heart-beating donors. Transpl Int. 2000; 13:303–310

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