Aim: Growing demand for kidney graft for end-stage renal disease patients is still far from fulfillment even recent expansion of kidney graft pool. The utilization of kidney graft from donation after cardiac death (DCD) is one of the solutions for expanding kidney graft pool, however short- and long-term outcome of kidney transplant from DCD donor is inferior to living or brain-dead donor. Agonal phase in DCD donor is known as important factor on graft survival after kidney transplant; indicating decision making on usage of DCD donor with long agonal phase is essential to better kidney graft survival. We, here, investigated factors contributing to the initial function of kidney grafts from DCD donor.
Methods: 1099 cases of kidney recipient from DCD donor, who were registered to the Japan Organ Network database between 1995 and 2014, were enrolled to this study. The donor age, underlying diseases and cause of death of the donor, presence and duration of anuria before organ retrieval, donor creatinine level, total and warm ischemia time of the graft and requirement for hemodialysis after kidney transplant were reviewed retrospectively.
Results: Among 1099 DCD donors, 295 donors fell into anuria before graft retrieval, with a mean duration of 15.4±14.0 hours. 1027 out of 1099 kidney recipients from DCD donor, hemodialysis was successfully withdrawn after transplantation (Control group). While 72 cases, dialysis was still required after transplant, defined as Primary Graft Failure (PGF group). Donor anuria occurred in 25 of 48 cases (52%) in the PGF group and in 269 of 736 cases (37%) in the Control group, significantly higher in the PGF group (P=0.04). The mean total ischemia time and warm ischemia time of the graft were also significantly longer in the PGF group (P<0.001). Logistic regression analysis revealed that duration of anuria and total ischemia time were significant factors contributing to post-transplant dialysis withdrawal (Table 1). Whereas decision tree analysis showed DOD elder than 54years old with more than 7 hours of anuria had negative impact on post-transplant dialysis withdrawal (Figure 1).
Conclusion: Donor age, underlying diseases, and cause of death did not contribute to the short-term graft function of kidneys from donors after cardiac death. Duration of anuria and total ischemia time of the graft were the most important factors for short-term kidney graft function after kidney transplantation from DCD donor.