%0 Journal Article
%T Kidney transplant from controlled donors following circulatory death: Results from the GEODAS-3 multicentre study.
%A Portolés JM
%A Pérez-Sáez MJ
%A López-Sánchez P
%A Lafuente-Covarrubias O
%A Juega J
%A Hernández D
%A Espí J
%A Navarro MD
%A Mazuecos MA
%A Rodríguez-Ferrero ML
%A Maruri-Kareaga N
%A Moreso F
%A Melilli E
%A de Souza E
%A Ruiz JC
%A Llamas F
%A Gutiérrez-Dalmau A
%A Guirado L
%A Martín-Moreno P
%A Pérez Flores I
%A Fernández-García A
%A Jiménez C
%A Gavela E
%A Ramos A
%A Pascual J
%A
%J Nefrologia (Engl Ed)
%V 39
%N 2
%D Mar 2019 0
%M 30497696
暂无%R 10.1016/j.nefro.2018.07.013
%X Many European countries have transplant programmes with controlled donors after cardiac death (cDCD). Twenty-two centres are part of GEODAS group. We analysed clinical results from a nephrological perspective.
Observational, retrospective and multicentre study with systematic inclusion of all kidney transplant recipients from cDCD, following local protocols regarding extraction and immunosuppression.
A total of 335 cDCD donors (mean age 57.2 years) whose deaths were mainly due to cardiovascular events were included. Finally, 566 recipients (mean age 56.5 years; 91.9% first kidney transplant) were analysed with a median of follow-up of 1.9 years. Induction therapy was almost universal (thymoglobulin 67.4%; simulect 32.8%) with maintenance with prednisone-MMF-tacrolimus (91.3%) or combinations with mTOR (6.5%). Mean cold ischaemia time (CIT) was 12.3h. Approximately 3.4% (n=19) of recipients experienced primary non-function, essentially associated with CIT (only CIT ≥ 14 h was associated with primary non-function). Delayed graft function (DGF) was 48.8%. DGF risk factors were CIT ≥ 14 h OR 1.6, previous haemodialysis (vs. peritoneal dialysis) OR 2.1 and donor age OR 1.01 (per year). Twenty-one patients (3.7%) died with a functioning graft, with a recipient and death-censored graft survival at 2-years of 95% and 95.1%, respectively. The estimated glomerular filtration rate at one year of follow-up was 60.9 ml/min.
CIT is a modifiable factor for improving the incidence of primary non-function in kidney transplant arising from cDCD. cDCD kidney transplant recipients have higher delayed graft function rate, but the same patient and graft survival compared to brain-dead donation in historical references. These results are convincing enough to continue fostering this type of donation.