Kidney donation after circulatory death in a country with a high number of brain dead donors: 10-year experience in Belgium.

Abstract

Worldwide shortage of standard brain dead donors (DBD) has revived the use of kidneys donated after circulatory death (DCD). We reviewed the Belgian DCD kidney transplant (KT) experience since its reintroduction in 2000. Risk factors for delayed graft function (DGF) were identified using multivariate analysis. Five-year patient/graft survival was assessed using Kaplan-Meier curves. The evolution of the kidney donor type and the impact of DCDs on the total KT activity in Belgium were compared with the Netherlands. Between 2000 and 2009, 287 DCD KT were performed. Primary nonfunction occurred in 1% and DGF in 31%. Five-year patient and death-censored graft survival were 93% and 95%, respectively. In multivariate analysis, cold storage (versus machine perfusion), cold ischemic time, and histidine-tryptophan-ketoglutarate solution were independent risk factors for the development of DGF. Despite an increased number of DCD donations and transplantations, the total number of deceased KT did not increase significantly. This could suggest a shift from DBDs to DCDs. To increase KT activity, Belgium should further expand controlled DCD programs while simultaneously improve the identification of all potential DBDs and avoid their referral for donation as DCDs before brain death occurs. Furthermore, living donation remains underused.

• Authors: Ina Jochmans, Tom Darius, Dirk Kuypers, Diethard Monbaliu, Eric Goffin, Michel Mourad, Hieu Ledinh, Laurent Weekers, Patrick Peeters, Caren Randon, Jean-Louis Bosmans, Geert Roeyen, Daniel Abramowicz, Anh-Dung Hoang, Luc De Pauw, Axel Rahmel, Jean-Paul Squifflet, Jacques Pirenne
• Journal: Transplant international : official journal of the European Society for Organ Transplantation (Transpl Int) Vol. 25 Issue 8 Pg. 857-66 (Aug 2012) ISSN: 1432-2277 [Electronic] Switzerland
• PMID: 22694305 (Publication Type: Journal Article)
• Copyright: © 2012 The Authors. Transplant International © 2012 European Society for Organ Transplantation.

Topics

• Adult
• Belgium
• Brain Death
• Cold Ischemia
• Death
• Delayed Graft Function (etiology)
• Female
• Graft Survival
• Humans
• Kidney Transplantation (statistics & numerical data)
• Male
• Middle Aged
• Tissue and Organ Procurement (methods)