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. 2021 Jul 16;7(8):e725.
doi: 10.1097/TXD.0000000000001174. eCollection 2021 Aug.

Kidney Transplants in Controlled Donation Following Circulatory Death, or Maastricht Type III Donors, With Abdominal Normothermic Regional Perfusion, Optimizing Functional Outcomes

Patricia Ramirez  1 , David Vázquez  1 , Gabriel Rodríguez  1 , Juan José Rubio  2 , Marina Pérez  2 , Jose Maria Portolés  3 , Joaquín Carballido  1
Affiliations

Kidney Transplants in Controlled Donation Following Circulatory Death, or Maastricht Type III Donors, With Abdominal Normothermic Regional Perfusion, Optimizing Functional Outcomes

Patricia Ramirez et al. Transplant Direct. .

Abstract

Background: Warm ischemia time and ischemia-reperfusion damage result in higher rates of delayed graft function and primary nonfunction in kidney transplants (KTs) from controlled donation after circulatory death (cDCD). This study aimed to assess early and late kidney function and patient and graft survival of KT from cDCD preserved with normothermic regional perfusion (NRP) and to compare with KT from brain death donors (DBDs) and cDCD preserved with rapid recovery (RR).

Methods: Patients who received a KT at our institution from 2012 to 2018 were included, with a minimum follow-up period of 1 y. They were categorized by donor type and conditioning methods: DBD, cDCD with NRP, and cDCD with RR. Early and late graft function, along with patient and graft survival were analyzed in all groups.

Results: A total of 182 KT recipients were included in the study (98 DBD and 84 cDCD). Out of the cDCDs, 24 kidneys were recovered with the use of NRP and 62 with RR; 22 of the 24 kidneys were ultimately transplanted. The cDCD using NRP group showed lower rates of delayed graft function compared with the cDCD with RR group (36.3% versus 46.7%, P = 0.01). Also, primary nonfunction rates were lower in the cDCD using NRP group (4.5% versus 6.4% cDCD-RR and 10.2% DBD). Patient survival rates were >90% in all groups. No differences were found in graft survival rates at 1 y.

Conclusions: The use of abdominal NRP improves early function recovery of KT from cDCD, making their outcomes comparable with those of DBD.

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Conflict of interest statement

The authors declare no funding or conflicts of interest.

Figures

FIGURE 1.
FIGURE 1.
A, Posttransplant kidney function in a descriptive graph. This graph represents the medians of creatinine levels of the 3 groups over time. The bars indicate the 25th and 75th percentiles. B, Linear prediction for creatinine over the time, at 1, 2, 4, 12, 24, and 53 wk posttransplant according to the type of donor and type of preservation. The bars indicate 95% CI. cDCD, controlled donation after circulatory death; CI, confidence interval; DBD, brain death donor; NRP, normothermic regional perfusion; RR, rapid recovery.
FIGURE 2.
FIGURE 2.
Kaplan-Meier survival curves for the 3 groups. Time is represented in months. Log-rank test for equality of survivor functions is P = 0.3062. cDCD, controlled donation after circulatory death; DBD, brain death donor; NRP, normothermic regional perfusion; RR, rapid recovery.
FIGURE 3.
FIGURE 3.
Graft survival curves truncated to 15 mo for all patients. cDCD, controlled donation after circulatory death; CIF, cumulative incidence function; DBD, brain death donor; NRP, normothermic regional perfusion; RR, rapid recovery.
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