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

Shanka K. Benaragama; Teressa Tymkewycz; Biku J. John; Andrew Davenport; [No Value] 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

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^*, Teressa Tymkewycz, Biku J. John, Andrew Davenport, [No Value] 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 PapaloisBimbi S. Fernando

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

7 Citations (Scopus)

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.

Original language	English
Article number	83
Number of pages	7
Journal	BMC Nephrology
Volume	15
DOIs	https://doi.org/10.1186/1471-2369-15-83
Publication status	Published - 22 May 2014

Keywords

Donation after circulatory death
Allocation
Kidney
Delayed graft function
Cold ischemia time
DELAYED GRAFT FUNCTION
RENAL-FUNCTION
ACUTE REJECTION
COLD ISCHEMIA
CARDIAC DEATH
DURATION
DIALYSIS
ERA

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10.1186/1471-2369-15-83

Cite this

Benaragama, S. K., Tymkewycz, T., John, B. J., Davenport, A., Ben Lindsey, N. V., Nicol, D., Olsburgh, J., Drage, M., Mamode, N., Calder, F., Taylor, J., Koffman, G., Kessaris, N., Morsy, M., Cacciola, R., Puliatti, C., Fernadez-Diaz, S., Syed, A., Hakim, N., ... Fernando, B. S. (2014). Do we need a different organ allocation system for kidney transplants using donors after circulatory death? BMC Nephrology, 15, Article 83. https://doi.org/10.1186/1471-2369-15-83

@article{60084118d3434a6e9ad39d5cf849ec82,

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

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.",

keywords = "Donation after circulatory death, Allocation, Kidney, Delayed graft function, Cold ischemia time, DELAYED GRAFT FUNCTION, RENAL-FUNCTION, ACUTE REJECTION, COLD ISCHEMIA, CARDIAC DEATH, DURATION, DIALYSIS, ERA",

author = "Benaragama, {Shanka K.} and Teressa Tymkewycz and John, {Biku J.} and Andrew Davenport and {Ben Lindsey}, {[No Value]} and David Nicol and Jonathon Olsburgh and Martin Drage and Nizam Mamode and Francis Calder and John Taylor and Geoff Koffman and Nicos Kessaris and Mohamed Morsy and Roberto Cacciola and Carmelo Puliatti and Susana Fernadez-Diaz and Asim Syed and Nadey Hakim and Vassilios Papalois and Fernando, {Bimbi S.}",

year = "2014",

month = may,

day = "22",

doi = "10.1186/1471-2369-15-83",

language = "English",

volume = "15",

journal = "BMC Nephrology",

issn = "1471-2369",