Risk stratification of kidneys from donation after cardiac death donors and the utility of machine perfusion

Alex Cantafio, A. A S Dick, J. B. Halldorson, R. Bakthavatsalam, J. D. Reyes, J. D. Perkins

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

There has been a dramatic increase in the utilization of kidneys from donors after cardiac death (DCD). While these organs represent an opportunity to expand the donor pool, the assessment of risk and optimal perioperative management remains unclear. Our primary aim was to identify risk factors for objective outcomes, and secondarily, we sought to determine what impact pulsatile machine perfusion (PMP) had on these outcomes. From 1993 to November 2008, 6057 DCD kidney transplants were reported to the Organ Procurement and Transplantation Network database, with complete endpoints for delayed graft function (DGF) and graft survival (GS). Risk factors were identified using a multivariable regression analysis adjusted for recipient factors. Age (50yr) [OR 1.81, p<0.0001] and cold ischemia time (CIT) (>30h) [OR 3.22, p<0.0001] were the strongest predictors of DGF. The use of PMP decreased the incidence of DGF only when donor age was >60yr and improved long-term graft survival when donor age was >50yr. Donor warm ischemia time >20min was also found to correlate with increased DGF. While the incidence of DGF in DCD kidneys is significantly higher, the only factors the transplant surgeon can control are CIT and the use of PMP. The data suggest that the use of PMP in DCD kidneys <50yr old provides little clinical benefit and may increase CIT.

Original languageEnglish (US)
JournalClinical Transplantation
Volume25
Issue number5
DOIs
StatePublished - Sep 2011
Externally publishedYes

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Perfusion
Tissue Donors
Kidney
Delayed Graft Function
Pulsatile Flow
Graft Survival
Transplants
Warm Ischemia
Tissue and Organ Procurement
Organ Transplantation
Regression Analysis
Databases
Incidence

All Science Journal Classification (ASJC) codes

  • Transplantation

Cite this

Risk stratification of kidneys from donation after cardiac death donors and the utility of machine perfusion. / Cantafio, Alex; Dick, A. A S; Halldorson, J. B.; Bakthavatsalam, R.; Reyes, J. D.; Perkins, J. D.

In: Clinical Transplantation, Vol. 25, No. 5, 09.2011.

Research output: Contribution to journalArticle

Cantafio, Alex ; Dick, A. A S ; Halldorson, J. B. ; Bakthavatsalam, R. ; Reyes, J. D. ; Perkins, J. D. / Risk stratification of kidneys from donation after cardiac death donors and the utility of machine perfusion. In: Clinical Transplantation. 2011 ; Vol. 25, No. 5.
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