The Outcome of Renal Transplants engrafting Grafts from DCD Donors and Risk Factors for the Long-term Graft Survival. - A Single Center Experience during the Three Decades -

Kiyotaka Hoshinaga¹, Mamoru Kusaka¹, Yusuke Kubota¹, Hitomi Sasaki¹, Naohiko Fukami¹, Masashi Takenaka¹, Taihei Itoh², Takashi Kenmochi², Ryoichi Shiroki¹

¹Urology, Fujita Health University, Toyoake, Japan, ²Transplant surgery, Fujita Health University, Toyoake, Japan

Introduction: In recent years, it is known that kidneys procured from donors after cardiac death (DCD) have a potential to expand the donor pool. In this study, the posttransplant outcome of renal allografts recovered from DCD donors is investigated and the risk factors affecting the renal prognoses were analyzed.

Study subjects: From April 1979 to Dec. 2012, 535 kidneys were retrieved from 270 DCD donors at our center, using in situ regional cooling technique. Only 49 (9.2%) grafts were discarded and 443 transplanted between 1983 and 2011 were enrolled in this study. The age of the donors and recipients ranged from 0.7 to 75 (mean; 47.6 years) and from 7 to 72 (mean; 41.7 years), respectively. The warm ischemic time (WIT) ranged from 1 to 71 minutes (mean; 11.7). The serum creatinine level before cardiac arrest ranged from 0.4 to 5.4 mg/dl (mean; 1.49). All the patients were treated with immunotherapy consisting of calcineurin inhibitos, steroid and others. For the statistical analysis, Kaplan-Meier method and Log-rank test were used.

Results: Following renal transplants, primary non-function was noted in 27 (6.5%), immediate function (IF) in 58 (13.1%), and delayed graft function in 358 (80.9%). The 1, 3, 5, and 10 year patient survival rates were 97.0%, 92.1%, 90.0%, and 82.9%, respectively. The 1, 3, 5, and 10 year graft survival rates were 86.1%, 75.6%, 68.5%, and 52.8%, respectively. The significant risk factors for the long-term graft survival were the donor age, cause of death (CVA), donor hypertension and WIT.

Conclusion: Kidneys procured from DCD donors had good renal function as well as excellent long term graft survival, when in situ regional cooling technique was applied. DCD donors should be the excellent resources of deceased donor renal grafts, and they should have a great potential to expand the donor pool in the era of severe organ shortage.