Faculty Collaboration Database

Does DCD Donor Time-to-Death Affect Recipient Outcomes? Implications of Time-to-Death at a High-Volume Center in the United States. Am J Transplant 2017 Jan;17(1):191-200

Date

07/05/2016

Pubmed ID

27375072

DOI

10.1111/ajt.13948

Scopus ID

2-s2.0-84983382773 (requires institutional sign-in at Scopus site)   25 Citations

Abstract

For donation after circulatory death (DCD), many centers allow 1 h after treatment withdrawal to donor death for kidneys. Our center has consistently allowed 2 h. We hypothesized that waiting longer would be associated with worse outcome. A single-center, retrospective analysis of DCD kidneys transplanted between 2008 and 2013 as well as a nationwide survey of organ procurement organization DCD practices were conducted. We identified 296 DCD kidneys, of which 247 (83.4%) were transplanted and 49 (16.6%) were discarded. Of the 247 recipients, 225 (group 1; 91.1%) received kidneys with a time to death (TTD) of 0-1 h; 22 (group 2; 8.9%) received grafts with a TTD of 1-2 h. Five-year patient survival was 88.8% for group 1, and 83.9% for group 2 (p = 0.667); Graft survival was also similar, with 5-year survival of 74.1% for group 1, and 83.9% for group 2 (p = 0.507). The delayed graft function rate was the same in both groups (50.2% vs. 50.0%, p = 0.984). TTD was not predictive of graft failure. Nationally, the average maximum wait-time for DCD kidneys was 77.2 min. By waiting 2 h for DCD kidneys, we performed 9.8% more transplants without worse outcomes. Nationally, this practice would allow for hundreds of additional kidney transplants, annually.

Author List

Scalea JR, Redfield RR, Arpali E, Leverson GE, Bennett RJ, Anderson ME, Kaufman DB, Fernandez LA, D'Alessandro AM, Foley DP, Mezrich JD

Author

Emre Arpali MD, PhD Associate Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Brain Death
Donor Selection
Female
Follow-Up Studies
Glomerular Filtration Rate
Graft Rejection
Graft Survival
Heart Arrest
Hospitals, High-Volume
Humans
Kidney Failure, Chronic
Kidney Function Tests
Kidney Transplantation
Male
Middle Aged
Prognosis
Registries
Retrospective Studies
Risk Factors
Time Factors
Tissue Donors
Tissue and Organ Procurement
United States