[en] 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
ª
Disciplines :
Surgery
Author, co-author :
Jochmans, Ina
Darius, Tom
Kuypers, Dirk
Monbaliu, Diethard
Goffin, Eric
Mourad, Michel
Ledinh, Hieu
WEEKERS, Laurent ; Centre Hospitalier Universitaire de Liège - CHU > Néphrologie
Peeters, Patrick
Randon, Caren
Bosmans, Jean-Louis
Roeyen, Geert
Abramowicz, Daniel
Hoang, Anh-Dung
De Pauw, Luc
Rahmel, Axel
SQUIFFLET, Jean-Paul ; Centre Hospitalier Universitaire de Liège - CHU > Chirurgie abdominale- endocrinienne et de transplantation
OPTN/SRTR Annual Report. Available at: Accessed December 2011.
Kootstra G,. History of non-heart-beating donation. In:, Talbot D, D'Alessandro A, eds. Organ donation and transplantation after cardiac death. Oxford, UK: Oxford University Press, 2009: 1-6.
Kokkinos C, Antcliffe D, Nanidis T, Darzi AW, Tekkis P, Papalois V,. Outcome of kidney transplantation from nonheart-beating versus heart-beating cadaveric donors. Transplantation 2007; 83: 1193.
Moers C, Leuvenink HG, Ploeg RJ,. Non-heart beating organ donation: overview and future perspectives. Transpl Int 2007; 20: 567.
Daemen JW, Oomen AP, Kelders WP, Kootstra G,. The potential pool of non-heart-beating kidney donors. Clin Transplant 1997; 11: 149.
Wijnen RM, Booster MH, Stubenitsky BM, de Boer J, Heineman E, Kootstra G,. Outcome of transplantation of non-heart-beating donor kidneys. Lancet 1995; 345: 1067.
Weber M, Dindo D, Demartines N, Ambuhl PM, Clavien PA,. Kidney transplantation from donors without a heartbeat. N Engl J Med 2002; 347: 248.
Summers DM, Johnson RJ, Allen J, et al. Analysis of factors that affect outcome after transplantation of kidneys donated after cardiac death in the UK: a cohort study. Lancet 2010; 376: 1303.
Barlow AD, Metcalfe MS, Johari Y, Elwell R, Veitch PS, Nicholson ML,. Case-matched comparison of long-term results of non-heart beating and heart-beating donor renal transplants. Br J Surg 2009; 96: 685.
Eurotransplant International Foundation, Leiden, the Netherlands. Available at: Accessed August 2011
Wet betreffende het wegnemen en transplanteren van organen, 18 juni 186. Law on organ retrieval and transplantation, 18 June 1986. Available at: Accessed December 2011.
European Commission. Eurostat Population Database. Available at: Accessed August 2011.
Herdman R, Beauchamp TL, Potts JT,. The Institute of Medicine's report on non-heart-beating organ transplantation. Kennedy Inst Ethics J 1998; 8: 83.
Belzer FO, Glass NR, Sollinger HW, Hoffmann RM, Southard JH,. A new perfusate for kidney preservation. Transplantation 1982; 33: 322.
Moers C, Smits JM, Maathuis MH, et al. Machine perfusion or cold storage in deceased-donor kidney transplantation. N Engl J Med 2009; 360: 7.
Jochmans I, Moers C, Smits JM, et al. Machine perfusion versus cold storage for the preservation of kidneys donated after cardiac death: a multicenter randomized controlled trial. Ann Surg 2010; 252: 756.
Watson CJE, Wells AC, Roberts RJ, et al. Cold Machine Perfusion Versus Static Cold Storage of Kidneys Donated After Cardiac Death: A UK Multicenter Randomized Controlled Trial. Am J Transplant 2010; 10: 1991.
Jochmans I, Moers C, Ploeg RJ, Pirenne J,. To perfuse of to not perfuse kidneys donated after cardiac death. Am J Transplant 2011; 11: 409.
Hoogland ER, Snoeijs MG, Winkens B, Christaans MH, van Heurn LW,. Kidney transplantation from donors after cardiac death: uncontrolled versus controlled Donation. Am J Transplant 2011; 11: 1427.
Roels L, Spaight C, Smits J, Cohen B,. Donation patterns in four European countries: data from the donor action database. Transplantation 2008; 86: 1738.
Rodriguez-Arias D, Wright L, Paredes D,. Success factors and ethical challenges of the Spanish Model of organ donation. Lancet 2010; 376: 1109.
Federal Public Service Health, Food Chain Safety and Environment. Available at
Varty K, Veitch PS, Morgan JD, Kehinde EO, Donnelly PK, Bell PR,. Response to organ shortage: kidney retrieval programme using non-heart beating donors. BMJ 1994; 308: 575.
Phillips AO, Snowden SA, Hillis AN, Bewick M,. Renal grafts from non-heart beating donors. BMJ 1994; 308: 575.
Andrews PA, Denton MD, Compton F, Koffman CG,. Outcome of transplantation of non-heart-beating donor kidneys. Lancet 1995; 346: 53.
Schlumpf R, Candinas D, Zollinger A, et al. Kidney procurement from non-heartbeating donors: transplantation results. Transpl Int 1992; 5: S424.
Squifflet JP,. Why did it take so long to start a non-heart-beating donor program in Belgium? Acta Chir Belg 2006; 106: 485.
Vanrenterghem Y,. Cautious approach to use of non-heart-beating donors. Lancet 2000; 356: 528. (Pubitemid 30611855)
Moers C, Varnav OC, van Heurn E, et al. The value of machine perfusion perfusate biomarkers for predicting kidney transplant outcome. Transplantation 2010; 90: 966.
Jochmans I, Moers C, Smits JM, et al. The prognostic value of renal resistance during hypothermic machine perfusion of deceased donor kidneys. Am J Transplant 2011; 11: 2214.
Jochmans I, Pirenne J,. Graft quality assessment in kidney transplantation: not an exact science yet! Curr Opin Organ Transplant 2011; 16: 174.
NHS Blood and Transplant: Transplant activity in the UK. Available at: Accessed December 2011.
Saidi RF, Bradley J, Greer D, et al. Changing pattern of organ donation at a single center: are potential brain dead donors being lost to donation after cardiac death? Am J Transplant 2010; 10: 2536.
Dominguez-Gil B, Haase-Kromwijk B, Van Leiden H, et al. Current situation of donation after circulatory death in European countries. Transpl Int 2011; 24: 676.
Fieux F, Losser MR, Bourgeois E, et al. Kidney retrieval after sudden out of hospital refractory cardiac arrest: a cohort of uncontrolled non heart beating donors. Crit Care 2009; 13: R141.
Sanchez-Fructuoso AI, Prats D, Torrente J, et al. Renal transplantation from non-heart beating donors: a promising alternative to enlarge the donor pool. J Am Soc Nephrol 2000; 11: 350.
Wet betreffende euthanasie, 28 mei 2002. Law on euthanasia, 28 May 2002. Available at: Accessed December 2011.
Ysebaert D, Van Beeumen G, De Greef K, et al. Organ procurement after euthanasia: Belgian experience. Transplant Proc 2009; 41: 585.
Detry O, Laureys S, Faymonville ME, et al. Organ donation after physician-assisted death. Transpl Int 2008; 21: 915.
Smets T, Bilsen J, Cohen J, Rurup ML, Deliens L,. Legal euthanasia in Belgium: characteristics of all reported euthanasia cases. Med Care 2010; 48: 187.
Levey AS, Danovitch G, Hou S,. Living donor kidney transplantation in the United States-looking back, looking forward. Am J Kidney Dis 2011; 58: 343.
Najarian JS, Chavers BM, McHugh LE, Matas AJ,. 20 years or more of follow-up of living kidney donors. Lancet 1992; 340: 807.
Ibrahim HN, Foley R, Tan L, et al. Long-term consequences of kidney donation. N Engl J Med 2009; 360: 459.
Hariharan S, Johnson CP, Bresnahan BA, Taranto SE, McIntosh MJ, Stablein D,. Improved graft survival after renal transplantation in the United States, 1988 to 1996. N Engl J Med 2000; 342: 605.
