1. Rapid Access in Donation After Circulatory Death (DCD): The Single-Center Experience With a Classic Pathway in Uncontrolled DCD Algorithm.
- Author
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Pabisiak, Krzysztof, Tejchman, Karol, Ostrowski, Marek, Ciechanowski, Kazimierz, and Sieńko, Jerzy
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ISOLATION perfusion , *TRANSPLANTATION of organs, tissues, etc. , *KIDNEY transplantation , *GLOMERULAR filtration rate , *HOMOGRAFTS - Abstract
• Pretransplant assessment of recovered organs includes donor's medical history and visual inspection on the back table. • The machine perfusion storage parameters registry must be sufficient to stratify risk for primary nonfunction of uncontrolled donation after circulatory death kidney allografts. • Rapid abdominal access is a feasible option in uncontrolled donation after circulatory death under efficient coordination of the transplant team. In Poland, 95% of organs for transplantation come from donation after brain death (DBD). In 2010, Poland officially joined the European countries in which donation after circulatory death is accepted by law. Currently, the Pomeranian Medical University Transplant Center is the only active location for uncontrolled donation after circulatory death (uDCD) in Poland. To estimate the results of uDCD kidney transplantation with a classical approach to organ recovery, we analyzed data from an early phase of uDCD program. Prospective observation of uDCD kidney allografts (group 1; n = 8) compared with DBD kidney allografts (group 2; n = 30). The organ recovery protocol was set up on rapid abdominal access without regional perfusion before procurement. The organs recovered from uDCD during a 24-month period increased the volume of kidneys transplanted at the center by 9.2%. Delayed graft function was diagnosed in 100% vs 46% of allografts (P =.03), respectively. Nevertheless, early posttransplant follow-up did not reveal any graft loss or recipient death cases in the DCD group. After 12 months of follow-up, the mean glomerular filtration rate was 44.5 vs 57.9 mL/min (P <.02), respectively. Crucial factors for acceptable results of uDCD are strict pretransplant assessment of recovered organs and efficient coordination of the transplant team. Conservative recovery protocol in uDCD under strict prerequisites is feasible to consider in the organ procurement pathway. Preliminary results provide space for an increase in the organ donor pool. [ABSTRACT FROM AUTHOR]
- Published
- 2022
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