Uncontrolled donation after circulatory death: comparison of two kidney preservation protocols on graft outcomes

BMC Nephrology

Vannary Meas-Yedid¹  William Hanf²  Didier Dorez³  Philip Robinson⁴  Cécile Chauvet⁵  Emmanuel Morelon⁵  Guillaume Marcotte⁶  Thomas Rimmelé⁶  Bernard Floccard⁶  Alexandre Faure⁶  Claire Delsuc⁶  Vanessa Labeye⁷  Maud Rabeyrin⁸  Julien Berthiller⁹  Xavier Matillon^1,10  Ricardo Codas^1,10  Lionel Badet^1,10 

[1] CNRS UMR 3691, Institut Pasteur, Bioimage Analyse Unit;Centre Hospitalier Alpes-Léman, service de Néphrologie;Centre Hospitalier Annecy Genevois, service de Coordination des Prélèvements d’Organes et de Tissus;Hospices Civils de Lyon, Direction de la Recherche Clinique et de l’Innovation;Hospices Civils de Lyon, Hôpital Edouard Herriot, Université Claude Bernard Lyon 1, service de Transplantation, Néphrologie et Immunologie Clinique;Hospices Civils de Lyon, Hôpital Edouard Herriot, Université Claude Bernard Lyon 1, service d’Anesthésie Réanimation;Hospices Civils de Lyon, Hôpital Edouard Herriot, service de Coordination des Prélèvements d’Organes et de Tissus;Hospices Civils de Lyon, Hôpital Edouard Herriot, service d’Anatomopathologie;Hospices Civils de Lyon, Hôpital Edouard Herriot, service d’Epidémiologie Clinique, Pôle Information Médicale Evaluation Recherche (unité statistiques);Hospices Civils de Lyon, Hôpital Edouard Herriot, service d’Urologie;

关键词: Kidney transplantation;    Donor selection;    Organ preservation;    Graft survival;    Glomerular filtration rate;    Fibrosis;   

DOI  :  10.1186/s12882-017-0805-1

来源: DOAJ

【 摘 要 】

Abstract Background Kidney transplantation following uncontrolled donation after circulatory death (uDCD) presents a high risk of delayed graft function due to prolonged warm ischemia time. In order to minimise the effects of ischemia/reperfusion injury during warm ischemia, normothermic recirculation recently replaced in situ perfusion prior to implantation in several institutions. The aim of this study was to compare these preservation methods on kidney graft outcomes. Methods The primary endpoint was the one-year measured graft filtration rate (mGFR). We collected retrospective data from 64 consecutive uDCD recipients transplanted over a seven-year period in a single centre. Results Thirty-two grafts were preserved by in situ perfusion and 32 by normothermic recirculation. The mean ± SD mGFR at 1 year post-transplantation was 43.0 ± 12.8 mL/min/1.73 m2 in the in situ perfusion group and 53.2 ± 12.8 mL/min/1.73 m2 in the normothermic recirculation group (p = 0.01). Estimated GFR levels were significantly higher in the normothermic recirculation group at 12 months (p = 0.01) and 24 months (p = 0.03) of follow-up. We did not find any difference between groups regarding patient and graft survival, delayed graft function, graft rejection, or interstitial fibrosis. Conclusions Function of grafts preserved by normothermic recirculation was better at 1 year and the results suggest that this persists at 2 years, although no difference was found in short-term outcomes. Despite the retrospective design, this study provides an additional argument in favour of normothermic recirculation.

【 授权许可】

Unknown