Original Article

Preservation of kidneys from controlled donors after cardiac death†

  1. J. Wind1,*,
  2. M. G. J. Snoeijs1,
  3. J. A. van der Vliet4,
  4. B. Winkens2,
  5. M. H. L. Christiaans3,
  6. A. J. Hoitsma5,
  7. L. W. E. van Heurn1

Article first published online: 8 JUN 2011

DOI: 10.1002/bjs.7543

Issue

British Journal of Surgery

British Journal of Surgery

Volume 98, Issue 9, pages 1260–1266, September 2011

Additional Information

How to Cite

Wind, J., Snoeijs, M. G. J., van der Vliet, J. A., Winkens, B., Christiaans, M. H. L., Hoitsma, A. J. and van Heurn, L. W. E. (2011), Preservation of kidneys from controlled donors after cardiac death. British Journal of Surgery, 98: 1260–1266. doi: 10.1002/bjs.7543

Author Information

  1. 1

    Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands

  2. 2

    Department of Methodology and Statistics, Maastricht University Medical Centre, Maastricht, The Netherlands

  3. 3

    Department of Internal Medicine, Division of Nephrology, Maastricht University Medical Centre, Maastricht, The Netherlands

  4. 4

    Department of Surgery, Division of Vascular and Transplant Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands

  5. 5

    Department of Nephrology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands

*Department of Surgery, Maastricht University Medical Centre, PO Box 5800, 6202 AZ Maastricht, The Netherlands.

  1. †

    Presented to the Organ Donation Congress, Berlin, Germany, October 2009, and to Bootcongres 2010, Rotterdam, The Netherlands, March 2010

Publication History

  1. Issue published online: 25 JUL 2011
  2. Article first published online: 8 JUN 2011
  3. Manuscript Accepted: 15 MAR 2011

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Direct aortic cannulation preferred

Abstract

Background:

Donation after cardiac death (DCD) expands the pool of donor kidneys, but is associated with warm ischaemic injury. Two methods are used to preserve kidneys from controlled DCD donors and reduce warm ischaemic injury: in situ preservation using a double-balloon triple-lumen catheter (DBTL) inserted via the femoral artery and direct cannulation of the aorta after rapid laparotomy. The aim of this study was to compare these two techniques.

Methods:

This was a retrospective cohort study of 165 controlled DCD procedures in two regions in the Netherlands between 2000 and 2006.

Results:

There were 102 donors in the DBTL group and 63 in the aortic group. In the aortic group the kidney discard rate was lower (4·8 versus 28·2 per cent; P < 0·001), and the warm (22 versus 27 min; P < 0·001) and the cold (19 versus 24 h; P < 0·001) ischaemia times were shorter than in the DBTL group. Risk factors for discard included preservation with the DBTL catheter (odds ratio (OR) 5·19, 95 per cent confidence interval 1·88 to 14·36; P = 0·001) and increasing donor age (1·05, 1·02 to 1·07; P < 0·001). Warm ischaemia time had a significant effect on graft failure (hazard ratio 1·04, 1·01 to 1·07; P = 0·009), and consequently graft survival was higher in the aortic cannulation group (86·2 per cent versus 76·8 per cent in the DBTL group at 1 year; P = 0·027).

Conclusion:

In this retrospective study, direct aortic cannulation appeared to be a better method to preserve controlled DCD kidneys. Copyright © 2011 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

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