DCD Kidneys Can Yield Good Outcomes

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QUEBEC CITY—A Canadian team has confirmed that kidney transplantation  donated after cardiac death (DCD) can result in good outcomes.

DCD kidney donation was common until the 1960s but has just regained popularity across North America recently. Surgeons at the London Health Sciences Centre, London, Ontario, have transplanted 63 DCD kidneys since July 2006. The one-year graft and patient survival were 96.4percent and 98.2 percent, respectively. The rate of delayed graft function (DGF) was 65.1 percent.

In a multivariate analysis, the surgeons found that machine perfusion of the kidneys prior to transplantation and reduced time from asystole to flushing have contributed to their gradually improved outcomes over time. They presented the findings at the Canadian Society of Transplantation's 2012 Annual Meeting.

Mike Moser, MD, and his colleagues examined their DCD kidney transplant learning curve. They compared the outcomes of the 31 procedures they performed between July 2006 and January 2009, and those of 32 they performed between March 2009 and October 2011.

Donor and recipient characteristics from the two time periods have not changed significantly. The time from asystole to flushing has also decreased significantly, from 16 to 12 minutes on average. Furthermore, a perfusion pump was used in 81.3 percent of the more recent cases compared with 25.8 percent of the earlier cases. The average time with mean arterial pressure (MAP) below 55 mm Hg decreased from 25 to 18 minutes, and cold ischemic time increased from 464 to 725 minutes on average. The average length of stay also dropped, from 16 to 13 days.

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