Open Access Highly Accessed Research article

Do we need a different organ allocation system for kidney transplants using donors after circulatory death?

Shanka K Benaragama17*, Teressa Tymkewycz2, Biku J John1, Andrew Davenport1, Ben Lindsey1, David Nicol1, Jonathon Olsburgh3, Martin Drage3, Nizam Mamode3, Francis Calder3, John Taylor3, Geoff Koffman3, Nicos Kessaris3, Mohamed Morsy4, Roberto Cacciola5, Carmelo Puliatti5, Susana Fernadez-Diaz5, Asim Syed6, Nadey Hakim6, Vassilios Papalois6 and Bimbi S Fernando1

Author Affiliations

1 UCL Centre for Nephrology, Royal Free hospital, London, UK

2 South Central Organ Donation Services, London, UK

3 Department of Renal Transplantation, Guys and St. Thomas’ Hospital, London, UK

4 Department of Renal Transplantation, St George’s Hospital, London, UK

5 Department of Renal Transplantation, Royal London & St Bart’s NHS Trust, London, UK

6 West London Renal Transplant Centre, Hammersmith Hospital, London, UK

7 Centre for Nephrology and Transplantation, Royal Free London NHS Trust, Pond Street, London NW3 2QG, UK

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BMC Nephrology 2014, 15:83  doi:10.1186/1471-2369-15-83

Published: 22 May 2014

Abstract

Background

There is no national policy for allocation of kidneys from Donation after circulatory death (DCD) donors in the UK. Allocation is geographical and based on individual/regional centre policies. We have evaluated the short term outcomes of paired kidneys from DCD donors subject to this allocation policy.

Methods

Retrospective analysis of paired renal transplants from DCD’s from 2002 to 2010 in London. Cold ischemia time (CIT), recipient risk factors, delayed graft function (DGF), 3 and 12 month creatinine) were compared.

Results

Complete data was available on 129 paired kidneys.115 pairs were transplanted in the same centre and 14 pairs transplanted in different centres. There was a significant increase in CIT in kidneys transplanted second when both kidneys were accepted by the same centre (15.5 ± 4.1 vs 20.5 ± 5.8 hrs p < 0.0001 and at different centres (15.8 ± 5.3 vs. 25.2 ± 5.5 hrs p = 0.0008). DGF rates were increased in the second implant following sequential transplantation (p = 0.05).

Conclusions

Paired study sequential transplantation of kidneys from DCD donors results in a significant increase in CIT for the second kidney, with an increased risk of DGF. Sequential transplantation from a DCD donor should be avoided either by the availability of resources to undertake simultaneous procedures or the allocation of kidneys to 2 separate centres.

Keywords:
Donation after circulatory death; Allocation; Kidney; Delayed graft function; Cold ischemia time