Clinical research of 97 cases of donation after citizen death kidney transplantations_West China Medical Journal

Authors：

HUANG Zhongli , JIANG Yamei , SONG Turun , WANG Xianding , FAN Yu , QIU Yang , LIU Jinpeng , WANG Li ,  LIN Tao

Department of Urology/Institute of Urology/Organ Transplant Centre, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

LIN Tao, Email: kidney5@163.com

Keywords：

Donation after citizen death; Kidney transplantation; Graft evaluate

DOI：

10.7507/1002-0179.201711188

Video：

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ObjectiveTo explore the effect of donation after citizen death (DCD) kidney transplantations performed in Sichuan.MethodsThe data of 97 cases of DCD kidney transplantations performed in West China Hospital of Sichuan University between January 2012 and March 2016 was retrospectively reviewed. The 53 donors were aged from 7 months to 54 years (with a median of 28 years, and lower quartile of 15 years and upper quartile of 45 years), including 40 males and 13 females; the causes of death included craniocerebral trauma in 21 cases, craniocerebral tumor in 12 cases, cerebrovascular accident in 15 cases, hypoxic-ischemic encephalopathy in 4 cases, and hydrocephalus in 1 case. The 97 recipients were aged from 18 to 66 years (with a median of 39 years, and lower quartile of 30 years and upper quartile of 44 years), including 71 males and 26 females. The recipients were classified into C-Ⅰ (n=36) and C-Ⅲ (n=61) according to type of donation. The baseline and perioperative situation of the donors and recipients, and the postoperative kidney function, infection, recipient survival and kidney survival of the recipients were analyzed.ResultsAfter transplantation, none of primary graft nonfunction occurred but delayed graft function (DGF) occurred in 26 cases. There were no significant differences in creatinine level between C-Ⅰ and C-Ⅲ recipients at 1 week [(226.71±187.46) vs. (249.94±249.84) μmol/L, P=0.636], 1 month [(136.32±63.34) vs. (157.37±147.83) μmol/L, P=0.428], 3 months [(110.51±25.26) vs. (115.02±36.60) μmol/L, P=0.527] and 12 months [(103.42±21.57) vs. (104.18±39.36) μmol/L, P=0.911] after transplantation, as well as acute rejection [13.9% vs. 19.7%, P=0.469] and complications at early time after transplantation. There were no significant differences in 1-year recipient survival rate (91.7% vs. 93.4%) and 1-year kidney survival rate (100.0% vs. 91.8%) between C-Ⅰ and C-Ⅲ recipients.ConclusionDCD kidney transplantation has excellent short-term outcomes despite a high incidence of early DGF, and may represent another potential method to safely expand the donor pool.

Citation： HUANG Zhongli, JIANG Yamei, SONG Turun, WANG Xianding, FAN Yu, QIU Yang, LIU Jinpeng, WANG Li, LIN Tao. Clinical research of 97 cases of donation after citizen death kidney transplantations. West China Medical Journal, 2018, 33(3): 307-311. doi: 10.7507/1002-0179.201711188 Copy

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13.	Snoeijs MG, Schaubel DE, Hené R, et al. Kidneys from donors after cardiac death provide survival benefit. J Am Soc Nephrol, 2010, 21(6): 1015-1021.
14.	Heilman RL, Mathur A, Smith ML, et al. Increasing the use of kidneys from unconventional and highrisk deceased donors. Am J Transplant, 2016, 16(11): 3086-3092.
15.	Irish WD, Mccollum D, Tesi RJ, et al. Nomogram for predicting the likelihood of delayed graft function in adult cadaveric renal transplant recipients. J Am Soc Nephrol, 2003, 14(11): 2967-2974.
16.	Randhawa P. Role of donor kidney biopsies in renal transplantation. Transplantation, 2001, 71(10): 1361-1365.
17.	Irish WD, Ilsley JN, Schnitzler M, et al. A risk prediction model for delayed graft function in the current era of deceased donor renal transplantation. Am J Transplant, 2010, 10(10): 2279-2286.
18.	Plata-Munoz JJ, Vazquez-Montes M, Friend PJ, et al. The deceased donor score system in kidney transplants from deceased donors after cardiac death. Transpl Int, 2010, 23(2): 131-139.
19.	Grinyó JM. Transplantation: does BMI sufficiently predict renal transplant outcomes?. Nat Rev nephro, 2012, 8(10): 5667.
20.	Farney AC, Rogers J, Orlando GA, et al. Evolving experience using kidneys from deceased donors with terminal acute kidney injury. J Am Coll Surg, 2013, 216(4): 645-655.
21.	Heilman RL, Smith ML, Kurian SM, et al. Transplanting kidneys from deceased donors with severe acute kidney injury. Am J Transplant, 2015, 15(8): 2143-2151.
22.	Pérez-Sáez MJ, Arcos E, Comas J, et al. Catalan renal registry committee: survival benefit from kidney transplantation using kidneys from deceased donors aged>75 years: a time-dependent analysis. Am J Transplant, 2016, 16(9): 2724-2733.
23.	Tanrisev M, Hoscoskun C, Asci G, et al. Long-term outcome of kidney transplantation from elderly living and expanded criteria deceased donors. Ren Fail, 2015, 37(2): 249-253.
24.	Tomita Y, Tojimbara T, Iwadoh K, et al. Long-term outcomes in kidney transplantation from expanded-criteria donors after circulatory death. Transplant Proc, 2017, 49(1): 45-48.
25.	宋晓杰, 李丹, 刘伟, 等. 肾移植术后肺部感染诊治进展. 中国老年学杂志, 2014, 34(8): 2312-2314.
26.	张朋朋, 明英姿, 叶啟发, 等. 肾移植术后重症肺部感染患者死亡危险因素分析. 中华移植杂志: 电子版, 2016, 10(2): 66-70.

1. Radhakrishnan J, Remuzzi G, Saran R, et al. Taming the chronic kidney disease epidemic: a global view of surveillance efforts. Kidney Int, 2014, 86(2): 246-250.
2. Garcia-Garcia G, Harden P, Chapman J, et al. The global role of kidney transplantation. Nephrol Dial Transplant, 2012, 17(3): 199-203.
3. Meier-Kriesche HU, Schold JD, Srinivas TR, et al. Kidney transplantation halts cardiovascular disease progression in patients with end-stage renal disease. Am J Transplant, 2004, 4(10): 1662-1668.
4. Perovic S, Jankovic S. Renal transplantation vs. hemodialysis: cost effectiveness analysis. Vojnosanit Pregl, 2009, 66(8): 639-644.
5. Huang J, Wang H, Fan ST, et al. The national program for deceased organ donation in China. Transplantation, 2013, 96(1): 5-9.
6. 中华医学会器官移植学分会. 中国心脏死亡器官捐献工作指南. 中华器官移植杂志, 2010, 31(7): 436-437.
7. Yarlagadda G, Coca SG, Garg AX, et al. Marked variation in the definition and diagnosis of delayed graft function: a systematic review. Nephrol Dial Transplant, 2008, 23(9): 2995-3003.
8. Sui WG, Yan Q, Xie SP, et al. Successful organ donation from brain dead donors in a Chinese organ transplantation center. Am J Transplant, 2011, 11(10): 2247-2249.
9. Chen GD, Shiu-Chung Ko D, Wang CX, et al. Kidney transplantation from donors after cardiac death: an initial report of 71 cases from China. Am J Transplant, 2013, 13(5): 1323-1326.
10. Huang J, Mao Y, Millis JM, et al. Government policy and organ transplantation in China. Lancet, 2008, 372(9654): 1937-1938.
11. Perico N, Cattaneo D, Sayegh MH, et al. Delayed graft function in kidney transplantation. Lancet, 2004, 364(9447): 1814-1827.
12. Summers DM, Johnson RJ, Allen J, et al. Analysis of factors that affect outcome after transplantation of kidneys donated after cardiac death in the UK: a cohort study. Lancet, 2010, 376(9749): 1303-1311.
13. Snoeijs MG, Schaubel DE, Hené R, et al. Kidneys from donors after cardiac death provide survival benefit. J Am Soc Nephrol, 2010, 21(6): 1015-1021.
14. Heilman RL, Mathur A, Smith ML, et al. Increasing the use of kidneys from unconventional and highrisk deceased donors. Am J Transplant, 2016, 16(11): 3086-3092.
15. Irish WD, Mccollum D, Tesi RJ, et al. Nomogram for predicting the likelihood of delayed graft function in adult cadaveric renal transplant recipients. J Am Soc Nephrol, 2003, 14(11): 2967-2974.
16. Randhawa P. Role of donor kidney biopsies in renal transplantation. Transplantation, 2001, 71(10): 1361-1365.
17. Irish WD, Ilsley JN, Schnitzler M, et al. A risk prediction model for delayed graft function in the current era of deceased donor renal transplantation. Am J Transplant, 2010, 10(10): 2279-2286.
18. Plata-Munoz JJ, Vazquez-Montes M, Friend PJ, et al. The deceased donor score system in kidney transplants from deceased donors after cardiac death. Transpl Int, 2010, 23(2): 131-139.
19. Grinyó JM. Transplantation: does BMI sufficiently predict renal transplant outcomes?. Nat Rev nephro, 2012, 8(10): 5667.
20. Farney AC, Rogers J, Orlando GA, et al. Evolving experience using kidneys from deceased donors with terminal acute kidney injury. J Am Coll Surg, 2013, 216(4): 645-655.
21. Heilman RL, Smith ML, Kurian SM, et al. Transplanting kidneys from deceased donors with severe acute kidney injury. Am J Transplant, 2015, 15(8): 2143-2151.
22. Pérez-Sáez MJ, Arcos E, Comas J, et al. Catalan renal registry committee: survival benefit from kidney transplantation using kidneys from deceased donors aged>75 years: a time-dependent analysis. Am J Transplant, 2016, 16(9): 2724-2733.
23. Tanrisev M, Hoscoskun C, Asci G, et al. Long-term outcome of kidney transplantation from elderly living and expanded criteria deceased donors. Ren Fail, 2015, 37(2): 249-253.
24. Tomita Y, Tojimbara T, Iwadoh K, et al. Long-term outcomes in kidney transplantation from expanded-criteria donors after circulatory death. Transplant Proc, 2017, 49(1): 45-48.
25. 宋晓杰, 李丹, 刘伟, 等. 肾移植术后肺部感染诊治进展. 中国老年学杂志, 2014, 34(8): 2312-2314.
26. 张朋朋, 明英姿, 叶啟发, 等. 肾移植术后重症肺部感染患者死亡危险因素分析. 中华移植杂志: 电子版, 2016, 10(2): 66-70.

West China Medical Journal

Clinical research of 97 cases of donation after citizen death kidney transplantations

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