Uncontrolled donation after circulatory death: comparison of two kidney preservation protocols on graft outcomes

Autor: Thomas Rimmelé, Cécile Chauvet, Bernard Floccard, Didier Dorez, Lionel Badet, Ricardo Codas, Philip Robinson, Vannary Meas-Yedid, Maud Rabeyrin, Claire Delsuc, Vanessa Labeye, Emmanuel Morelon, Alexandre Faure, William Hanf, Julien Berthiller, Guillaume Marcotte, Xavier Matillon
Přispěvatelé: Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon, Physiopathologie de l'immunodépression associée aux réponses inflammatoires systémiques / Pathophysiology of Injury-induced Immunosuppression (PI3), Université de Lyon-Université de Lyon, Centre Hospitalier Annecy-Genevois [Saint-Julien-en-Genevois], Analyse d'images biologiques - Biological Image Analysis (BIA), Institut Pasteur [Paris] (IP)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Alpes Léman (CHAL)
Rok vydání: 2017
Předmět:
Nephrology
Adult
Graft Rejection
Male
medicine.medical_specialty
030232 urology & nephrology
Ischemia
Organ preservation
Renal function
Delayed Graft Function
[SDV.CAN]Life Sciences [q-bio]/Cancer
030230 surgery
lcsh:RC870-923
[SDV.MHEP.UN]Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology
03 medical and health sciences
0302 clinical medicine
[INFO.INFO-LG]Computer Science [cs]/Machine Learning [cs.LG]
Internal medicine
Medicine
Humans
Kidney transplantation
Retrospective Studies
Kidney
Warm Ischemia Time
business.industry
Donor selection
Graft Survival
[INFO.INFO-CV]Computer Science [cs]/Computer Vision and Pattern Recognition [cs.CV]
Shock
[SDV.IMM.IMM]Life Sciences [q-bio]/Immunology/Immunotherapy
Middle Aged
lcsh:Diseases of the genitourinary system. Urology
medicine.disease
Kidney Transplantation
Fibrosis
Tissue Donors
Heart Arrest
medicine.anatomical_structure
Treatment Outcome
[INFO.INFO-TI]Computer Science [cs]/Image Processing [eess.IV]
Anesthesia
Female
Glomerular filtration rate
business
Reperfusion injury
Follow-Up Studies
Research Article
Zdroj: BMC Nephrology
BMC Nephrology, 2018, 19 (1), pp.3. ⟨10.1186/s12882-017-0805-1⟩
BMC Nephrology, Vol 19, Iss 1, Pp 1-9 (2018)
ISSN: 1471-2369
DOI: 10.1186/s12882-017-0805-1⟩
Popis: Background Kidney transplantation following uncontrolled donation after circulatory death (uDCD) presents a high risk of delayed graft function due to prolonged warm ischemia time. In order to minimise the effects of ischemia/reperfusion injury during warm ischemia, normothermic recirculation recently replaced in situ perfusion prior to implantation in several institutions. The aim of this study was to compare these preservation methods on kidney graft outcomes. Methods The primary endpoint was the one-year measured graft filtration rate (mGFR). We collected retrospective data from 64 consecutive uDCD recipients transplanted over a seven-year period in a single centre. Results Thirty-two grafts were preserved by in situ perfusion and 32 by normothermic recirculation. The mean ± SD mGFR at 1 year post-transplantation was 43.0 ± 12.8 mL/min/1.73 m2 in the in situ perfusion group and 53.2 ± 12.8 mL/min/1.73 m2 in the normothermic recirculation group (p = 0.01). Estimated GFR levels were significantly higher in the normothermic recirculation group at 12 months (p = 0.01) and 24 months (p = 0.03) of follow-up. We did not find any difference between groups regarding patient and graft survival, delayed graft function, graft rejection, or interstitial fibrosis. Conclusions Function of grafts preserved by normothermic recirculation was better at 1 year and the results suggest that this persists at 2 years, although no difference was found in short-term outcomes. Despite the retrospective design, this study provides an additional argument in favour of normothermic recirculation. Electronic supplementary material The online version of this article (10.1186/s12882-017-0805-1) contains supplementary material, which is available to authorized users.
Databáze: OpenAIRE
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