Study Identifies Possible Way to Reduce Kidney Discard Rate

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Limiting cold ischemia times could increase the use of renal allografts donated from patients after death from cardiovascular causes, researchers say.
Limiting cold ischemia times could increase the use of renal allografts donated from patients after death from cardiovascular causes, researchers say.

Donation after circulatory death (DCD) kidneys may be underutilized in the United States compared with the United Kingdom and other countries. Now a new study published in the Journal of the American Society of Nephrology (JASN) reveals a way to minimize DCD kidney damage so the organs are better preserved for transplantation.

Based on national data from 2008 to 2015, a quarter of donor service areas recovered fewer than 10 DCD kidneys, reported John Gill, MD, MS, of the University of British Columbia in Vancouver, and colleagues. A full 25% of DCD kidneys were recovered in just 4 of the 58 donor service areas. In addition, 1 in 5 recovered DCD kidneys were discarded, with rates ranging from 3% to 33% among donor service areas.

Compared with kidneys harvest from neurologically brain dead (NBD) donors, more DCD kidneys are discarded. DCD kidneys with longer warm ischemic times were commonly refused. The odds of discard were 1.3 and 2.7 times higher for DCD kidneys with total warm ischemic times of 10 to 26 minutes and more than 48 minutes, respectively, compared with NBD kidneys. Total warm ischemic time started with the withdrawal of life support and lasted until the onset of cold perfusion.

DCD allografts are associated with good survival rates; 75% were still surviving at the 5-year benchmark. Among the 12,831 DCD kidneys transplanted, DCD kidneys with total warm ischemic times of 48 minutes or less showed survival rates similar to that of NBD kidneys. When warm ischemia was longer than 48 minutes, the risk for allograft failure increased by 23% -- but only when cold ischemia time was longer than 12 hours. Reducing cold ischemia time might prevent injury and lead to better results, according to the investigators.

“We found that use of DCD kidneys is variable throughout the United States, that the outcomes are generally excellent, and that the use of these organs could probably be safely increased if cold ischemia times are limited,” Dr Gill commented in a release from the American Society of Nephrology, the publishers of JASN.

References

Gill J, Rose C, Lesage J, et al. Use and outcomes of kidneys from donation after circulatory death donors in the United States. J Am Soc Nephrol. doi 10.1681/ASN.2017030238 [Epub October 5, 2017].

Study offers insights on how to decrease the discard rate of donated organs [news release]. American Society of Nephrology; October 5, 2017.

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