Impact of donor age on outcome of kidney transplantation from controlled donation after cardiac death

Previous reports regarding donation after cardiac death (DCD) have called for caution in extending the age of kidney donors beyond 60 years due to the risk of poor graft function. The aim of this study was to determine the impact of donor age on renal transplantation from DCD in one center. All DCD transplants from 2005 to 2009 were included in the study. Immunosuppression and recipient follow-up were as per unit protocol. Donor and recipient details were entered prospectively into a renal database and analyzed for graft outcome. Of the 147 renal transplants, 102 were from donors <60 years old and 45 were from donors ≥60 years old. The incidence of delayed graft function varied significantly according to donor-recipient age groups (P = 0.01). The mean glomerular filtration rate at 12 months was 50.3 mL/min for transplants from young donors compared with 39.3 mL/min for transplants from old donors (P = 0.001). The cumulative graft survival rates at 1 and 5 years were 88% and 79% for young donors, while for old donors these were 78% and 72%, respectively (P = 0.101). By transplanting kidneys from old DCD donors into elderly patients, their survival is improved compared with dialysis, and organs from younger donors are made available for younger recipients.

Early results of a controlled non-heart-beating kidney donor programme

BACKGROUND

We present our experience of a controlled non-heart beating donation (CNHBD) programme in a University Hospital.

METHODS

Data from all referrals for CNHBD between January 2005 and January 2008 were collected prospectively. Donor and recipient data were analysed and compared to other cadaveric and HBD transplants performed during the same period.

RESULTS

During the period, 79 donors were referred resulting in 35 proceeding to retrieval and 61 kidneys being successfully transplanted. The median time from withdrawal of therapy to asystole was 15 min (IQR 10.0-23.0). The median primary warm ischaemic time was 20 min (IQR 16.0-27.0). The mean cold ischaemia time was 16.6 +/- 4.21 h for CNHBD (16.6 +/- 5.91 for HBD) kidneys. Compared to HBD kidneys, CNHBD kidneys had more HLA mismatches and significantly more delayed graft function (44% versus 14%), and the mean time to halving of serum creatinine was significantly greater (12.8 versus 5 days). However, 1-year patient and graft survival (88% and 93%) were excellent and mean creatinine at 12 months for CNHB kidneys was not significantly different from HBD kidneys (141 mumol/l versus 131 mumol/l).

CONCLUSIONS

Structured implementation resulted in a successful CNHBD programme providing 61 successful renal transplants from 35 donors in 3 years-contributing to approximately 50% of the total number of cadaveric renal transplants during the period. At 12 months, CNHBD kidney graft function was equivalent to HBD organs.