Kidney donation after circulatory death in a country with a high number of brain dead donors: 10 -year experience in Belgium

Worldwide shortage of standard brain dead donors (DBD) has revived the use
of kidneys donated after circulatory death (DCD). We reviewed the Belgian
DCD kidney transplant (KT) experience since its reintroduction in 2000. Risk
factors for delayed graft function (DGF) were identified using multivariate
analysis. Five-year patient/graft survival was assessed using Kaplan–Meier
curves. The evolution of the kidney donor type and the impact of DCDs on
the total KT activity in Belgium were compared with the Netherlands. Between
2000 and 2009, 287 DCD KT were performed. Primary nonfunction occurred
in 1% and DGF in 31%. Five-year patient and death-censored graft survival
were 93% and 95%, respectively. In multivariate analysis, cold storage (versus
machine perfusion), cold ischemic time, and histidine-tryptophan-ketoglutarate
solution were independent risk factors for the development of DGF. Despite an
increased number of DCD donations and transplantations, the total number of
deceased KT did not increase significantly. This could suggest a shift from
DBDs to DCDs. To increase KT activity, Belgium should further expand controlled
DCD programs while simultaneously improve the identification of all
potential DBDs and avoid their referral for donation as DCDs before brain
death occurs. Furthermore, living donation remains underused.
Transplant International ISSN 0934-0874
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