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DBD renal transplantation

Hessel Peters-Sengers, Stefan P Berger, Martin B A Heemskerk, Doaa Al Arashi, Jaap J Homan van der Heide, Aline C Hemke, Ineke J M Ten Berge, Mirza M Idu, Michiel G H Betjes, Arjan D van Zuilen, Luuk B Hilbrands, Aiko P J de Vries, Azam S Nurmohamed, Maarten H Christiaans, L W Ernest van Heurn, Johan W de Fijter, Frederike J Bemelman
An increasing number of elderly patients (≥65 years) receive a donor kidney from elderly donors after brain death (DBD) or after circulatory death (DCD). These organs are allocated within the Eurotransplant Senior Program, but outcomes must be evaluated. From the Dutch Organ Transplantation Registry, we selected 3597 recipients (≥18 years) who received a first DBD or DCD kidney during 2002-2012, and categorized them as young or elderly recipients receiving a graft from either a young or elderly donor, stratified by donor type...
October 11, 2016: Journal of the American Society of Nephrology: JASN
H Leiden, B Haase-Kromwijk, A Hoitsma, N Jansen
BACKGROUND: The Netherlands was one of the first countries in Europe to stimulate controlled donation after circulatory death (cDCD) at a national level in addition to donation after brain death (DBD). With this program the number of organ transplants increased, but it also proved to have challenges as will be shown in this 15-year review. METHODS: Data about deceased organ donation in the Netherlands, from 2000 until 2014, were analysed taking into account the whole donation process from donor referral to the number of organs transplanted...
August 2016: Netherlands Journal of Medicine
Xiaoli Fan, Zhiquan Chen, David Nasralla, Xianpeng Zeng, Jing Yang, Shaojun Ye, Yi Zhang, Guizhu Peng, Yanfeng Wang, Qifa Ye
Between 2010 and 2013, we recorded 66 cases of failed organ donation after brain death (DBD) due to the excessive use of the vasoactive drugs resulting in impaired hepatic and/or renal function. To investigate the effect of extracorporeal membrane oxygenation (ECMO) in donor management, ECMO was used to provide support for DBD donors with circulatory and/or respiratory failure from 2013 to 2015. A retrospective cohort study between circulatory non-stable DBD with vasoactive drugs (DBD-drug) and circulatory non-stable DBD with ECMO (DBD-ECMO) was designed to compare the transplant outcomes...
October 2016: Clinical Transplantation
Siegfredo Paloyo, Junichiro Sageshima, Jeffrey J Gaynor, Linda Chen, Gaetano Ciancio, George W Burke
Kidney grafts are often preserved initially in static cold storage (CS) and subsequently on hypothermic machine perfusion (MP). However, the impact of CS/MP time on transplant outcome remains unclear. We evaluated the effect of prolonged CS/MP time in a single-center retrospective cohort of 59 donation after circulatory death (DCD) and 177 matched donation after brain death (DBD) kidney-alone transplant recipients. With mean overall CS/MP times of 6.0 h/30.0 h, overall incidence of delayed graft function (DGF) was higher in DCD transplants (30...
October 2016: Transplant International: Official Journal of the European Society for Organ Transplantation
Matko Marlais, Laura Pankhurst, Alex Hudson, Khalid Sharif, Stephen D Marks
BACKGROUND: Donation after circulatory death (DCD) kidney transplantation has acceptable renal allograft survival in adults but there are few data in pediatric recipients. The aim of this study was to determine renal allograft outcomes for pediatric recipients of a DCD kidney. METHODS: Data were collected from the UK Transplant Registry held by National Health Service Blood and Transplant. Kidney transplants performed for pediatric recipients (age, <18 years) in the United Kingdom from 2000 to 2014 were separated into DCD, donation after brain death (DBD), and living donor (LD) transplants, analyzing 3-year patient and renal allograft survival...
June 29, 2016: Transplantation
Matko Marlais, Alex Hudson, Laura Pankhurst, Susan V Fuggle, Stephen D Marks
BACKGROUND: Living donor (LD) kidney transplantation accounts for around half of all pediatric renal transplant recipients and results in improved renal allograft survival. The aim of this study was to determine the effect of HLA matching on deceased and LD renal allograft outcomes in pediatric recipients. METHODS: Data were obtained from the UK Transplant Registry held by NHS Blood and Transplant on all children who received a donation after brain death (DBD) or LD kidney-only transplant between 2000 and 2011...
March 16, 2016: Transplantation
John M O'Callaghan, Simon R Knight, Robert D Morgan, Peter J Morris
BACKGROUND: The preservation fluids most commonly used for renal allograft preservation in the UK are University of Wisconsin Solution (UW, £120 per liter) and Marshall's Solution (hyperosmolar citrate, £10 per liter). The aim of this study was to compare the outcomes of deceased donor renal allografts preserved with these fluids using data from the UK national transplant registry. METHODS: Data regarding transplants performed between January 1, 2005, and December 31, 2008, was analyzed (n = 5027 kidneys)...
January 12, 2016: Transplantation
M A Gentil, C Gonzalez-Corvillo, P Castro, P Ruiz-Esteban, C Gracia-Guindo, T Garcia-Alvarez, M L Agüera, L Ballesteros, A Osuna, M Alonso
BACKGROUND: Kidneys from donors after brain death (DBD) cannot meet the demand for renal transplants in Andalusia. METHODS: We analyzed the impact of using non-heart-beating donors (NHBD) in Andalusia from the start of this program to the present. RESULTS: From 2010 to 2014, brain-death kidney donations remained at a standstill (1,635 in total) although NHBD increased from 2.4% to 16% annually, to 5% of the total (n = 164: 83 type II Maastricht [NHBD-T2] and 81 type III Maastricht [NHBD-T3])...
November 2015: Transplantation Proceedings
M A Gentil, P Castro, L Ballesteros, M C Gracia-Guindo, M Cabello, M A Mazuecos, A Rodriguez-Benot, C Gonzalez-Corvillo, J Borrego, A O Ortega, M Alonso
BACKGROUND: Donors after circulatory death (DCD) are an increasingly crucial source of organs to maintain deceased donor kidney transplant activity when faced with a standstill in donors after brain death (DBD). We analyzed the influence on graft survival since the use of DCD organs was implemented in Andalusia (2010-2014). METHODS: We compared 164 kidney transplants from DCD (83 Maastricht type II and 81 type III) and 1488 DBD transplants in recipients over the age of 18, excluding combined transplants...
November 2015: Transplantation Proceedings
Ana Sánchez-Escuredo, Fritz Diekmann, Ignacio Revuelta, Nuria Esforzado, Maria Jose Ricart, Frederic Cofán, Jose-Vicente Torregrosa, Lluis Peri, Ángel Ruiz, Josep Maria Campistol, Federico Oppenheimer
Donor after cardiac death (DCD) grafts have excellent survival despite the high incidence of delayed graft function (DGF). We assessed the feasibility of a mammalian target of rapamycin inhibitor (mTOR-I) protocol in uncontrolled DCD kidney transplantation and compared it with brain-dead donor (DBD) transplantation under calcineurin inhibitor (CNI) treatment. This retrospective study (2002-2011) included 109 Maastricht category II DCD patients and 218 standard-criteria DBD as controls. Immunosuppression consisted of polyclonal antibody induction, mycophenolate mofetil, prednisone, and mTOR-I (starting on day 6) in the DCD group and tacrolimus in the DBD group...
March 2016: Transplant International: Official Journal of the European Society for Organ Transplantation
V Kosmoliaptsis, M Salji, V Bardsley, Y Chen, S Thiru, M H Griffiths, H C Copley, K Saeb-Parsy, J A Bradley, N Torpey, G J Pettigrew
Histological assessment of baseline chronic kidney injury may discriminate kidneys that are suitable for transplantation, but has not been validated for appraisal of donation after circulatory death (DCD) kidneys. 'Time-zero' biopsies for 371 consecutive, solitary, deceased-donor kidneys transplanted at our center between 2006 and 2010 (65.5% DCD, 34.5% donation after brain death [DBD]) were reviewed and baseline chronic degenerative injury scored using Remuzzi's classification. High scores correlated with donor age and extended criteria donors (42% of donors), but the spectrum of scores was similar for DCD and DBD kidneys...
March 2015: American Journal of Transplantation
Jeffrey Damman, Vincent W Bloks, Mohamed R Daha, Peter J van der Most, Bahram Sanjabi, Pieter van der Vlies, Harold Snieder, Rutger J Ploeg, Christina Krikke, Henri G D Leuvenink, Marc A Seelen
BACKGROUND: In the last few decades, strategies to improve allograft survival after kidney transplantation have been directed to recipient-dependent mechanisms of renal injury. In contrast, no such efforts have been made to optimize organ quality in the donor. Optimizing deceased donor kidney quality opens new possibilities to improve renal allograft outcome. METHODS: A total of 554 kidney biopsies were taken from donation after brain death (DBD) and donation after cardiac death (DCD) kidneys before donation, after cold ischemia and after reperfusion...
June 2015: Transplantation
Kerrick Hesse, Emma Aitken, Marc Clancy, Alex Vesey
INTRODUCTION: Due to the rising disparity between demand and availability, organs from expanded criteria donors (ECD) and donors after determination of circulatory death (DCD) are increasingly used. The purpose of this study was to report outcomes in recipients of ECD and DCD renal allografts from a single centre. METHODS: A retrospective analysis from a single centre for all renal transplants performed between 2001 and 2010 inclusive was undertaken. SCD (standard criteria donor) and ECD organs were compared, as were DCD and DBD (donation after determination of brain stem death) organs...
June 2016: Surgeon: Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland
Tarek Alhamad, Christin Spatz, Tadahiro Uemura, Eric Lehman, Umar Farooq
BACKGROUND: There has been a remarkable increase in simultaneous liver and kidney transplantations (SLK). As organ demand has increased, so has the use of donation after cardiac death (DCD). However, little is known about the outcomes of DCD in SLK. METHODS: We performed a retrospective analysis using the United Network for Organ Sharing database to compare the outcomes of DCD SLK to donation after brain death (DBD) and determine the impact of donor and recipient factors on allograft and patient survival...
December 15, 2014: Transplantation
Willem G van Rijt, Niels Secher, Anna K Keller, Ulla Møldrup, Yahor Chynau, Rutger J Ploeg, Harry van Goor, Rikke Nørregaard, Henrik Birn, Jørgen Frøkiaer, Søren Nielsen, Henri G D Leuvenink, Bente Jespersen
Delayed graft function and primary non-function are serious complications following transplantation of kidneys derived from deceased brain dead (DBD) donors. α-melanocyte stimulating hormone (α-MSH) is a pleiotropic neuropeptide and its renoprotective effects have been demonstrated in models of acute kidney injury. We hypothesized that α-MSH treatment of the recipient improves early graft function and reduces inflammation following DBD kidney transplantation. Eight Danish landrace pigs served as DBD donors...
2014: PloS One
Xiongxiong Pan, Worapot Apinyachon, Wei Xia, Johnny C Hong, Ronald W Busuttil, Randolph H Steadman, Victor W Xia
Donation after cardiac death (DCD) is an important source for expanding the donor pool for liver transplantation (LT). Although the long-term outcomes of LT using DCD grafts have been extensively studied, perioperative complications related to DCD grafts are rarely reported. The aim of this study was to determine whether DCD grafts were associated with a higher incidence of postreperfusion complications and worse outcomes in adult LT patients. After institutional review board approval, the medical records of all adult patients who underwent LT at our medical center between 2004 and 2011 were reviewed...
July 2014: Liver Transplantation
Hani M Wadei, Ilynn G Bulatao, Thomas A Gonwa, Martin L Mai, Mary Prendergast, Andrew P Keaveny, Barry G Rosser, C Burcin Taner
Limited data are available for outcomes of simultaneous liver-kidney (SLK) transplantation using donation after cardiac death (DCD) donors. The outcomes of 12 DCD-SLK transplants and 54 SLK transplants using donation after brain death (DBD) donors were retrospectively compared. The baseline demographics were similar for the DCD-SLK and DBD-SLK groups except for the higher liver donor risk index for the DCD-SLK group (1.8 ± 0.4 versus 1.3 ± 0.4, P = 0.001). The rates of surgical complications and graft rejections within 1 year were comparable for the DCD-SLK and DBD-SLK groups...
June 2014: Liver Transplantation
K J Halazun, G Marangoni, A Hakeem, S M Fraser, S G Farid, N Ahmad
INTRODUCTION: The neutrophil-lymphocyte ratio (NLR) is an indicator of inflammatory status. We studied the effect of preoperative elevated NLR in the recipient in relation to the risk of developing delayed graft function (DGF) after kidney transplantation. METHODS: We retrospectively analysed the preoperative white blood cell count of renal transplant recipients between 2003 and 2005. An NLR >3.5 was considered elevated. There were 398 kidney transplant recipients of whom 249 received organs from donors after brain death (DBD), 61 from donors after circulatory death (DCD), and 88 from living donors...
November 2013: Transplantation Proceedings
Kunj K Desai, Cesar Mora-Esteves, Bart K Holland, George Dikdan, Adrian Fisher, Dorian J Wilson, Baburao Koneru
BACKGROUND: It is unclear whether ischemic preconditioning (IPC) of solid organs induces remote IPC (RIPC) in donors after brain death (DBD). METHODS: Outcomes in kidney recipients from 163 DBD in two randomized trials of liver IPC (5 min=62 and 10 min=101) were obtained retrospectively from the Scientific Registry of Transplant Recipients. Controls were kidney recipients from donors without IPC. Mean cold ischemia times were less than 20 hr. Primary outcomes were delayed graft function, defined as dialysis during the first posttransplantation week, and death-censored graft survival...
February 15, 2014: Transplantation
Dermot H Mallon, Dominic M Summers, J Andrew Bradley, Gavin J Pettigrew
BACKGROUND: Delayed graft function (DGF) after renal transplantation can be diagnosed according to several different definitions, complicating comparison between studies that use DGF as an endpoint. This is a particular problem after transplantation with kidneys from donation after circulatory death (DCD) kidneys, because DGF is common, and its relationship to early graft failure may differ depending on the definition of DGF. METHODS: The presence of DGF in 213 donation after brain death (DBD) and 312 DCD kidney transplants from October 2005 to August 2011 was determined according to 10 different, but widely used, definitions (based on dialysis requirements, creatinine changes, or both)...
November 27, 2013: Transplantation
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