Major determinants of primary non function from kidney donation after Maastricht II circulatory death: A single center experience

Ana Gaspar; Madalena Gama; Gustavo Nobre de Jesus; Sara Querido; Juliana Damas; João Oliveira; Marta Neves; Alice Santana; João Miguel Ribeiro

doi:10.1016/j.jcrc.2024.154811

Major determinants of primary non function from kidney donation after Maastricht II circulatory death: A single center experience

J Crit Care. 2024 Apr 10:82:154811. doi: 10.1016/j.jcrc.2024.154811. Online ahead of print.

Authors

Ana Gaspar¹, Madalena Gama², Gustavo Nobre de Jesus³, Sara Querido⁴, Juliana Damas⁵, João Oliveira⁶, Marta Neves⁶, Alice Santana⁶, João Miguel Ribeiro⁷

Affiliations

¹ Intensive Care Department, Unidade Local de Saúde Santa Maria EPE, Lisbon, Portugal; ECMO Referral Centre, Unidade Local de Saúde Santa Maria EPE, Lisbon, Portugal. Electronic address: ana.c.s.gaspar@chln.min-saude.pt.
² Clínica Universitária de Medicina Intensiva, Faculdade de Medicina da Universidade de Lisboa, Portugal.
³ Intensive Care Department, Unidade Local de Saúde Santa Maria EPE, Lisbon, Portugal; ECMO Referral Centre, Unidade Local de Saúde Santa Maria EPE, Lisbon, Portugal; Clínica Universitária de Medicina Intensiva, Faculdade de Medicina da Universidade de Lisboa, Portugal; Transplant Coordination Department, Unidade Local de Saúde Santa Maria EPE, Lisbon, Portugal.
⁴ Nephrology and Transplantation Department, Unidade Local de Saúde Lisboa Ocidental EPE, Lisbon, Portugal.
⁵ Nephrology and Transplantation Department, Unidade Local de Saúde São José EPE, Lisbon, Portugal.
⁶ Nephrology and Transplantation Department, Unidade Local de Saúde Santa Maria EPE, Lisbon, Portugal.
⁷ Intensive Care Department, Unidade Local de Saúde Santa Maria EPE, Lisbon, Portugal; ECMO Referral Centre, Unidade Local de Saúde Santa Maria EPE, Lisbon, Portugal.

PMID: 38603852
DOI: 10.1016/j.jcrc.2024.154811

Abstract

Purpose: Organ shortage greatly limits treatment of patients with end-stage chronic kidney. Maastricht type 2 donation after circulatory death (DCD) has been shown to have similar results in long term outcomes in kidney transplantation, when compared with brain dead donation. Our main goal was to assess Maastricht type 2 DCD and evaluate factors that impact on early graft function.

Methods: A retrospective study was conducted in an ECMO Referral Centre. All patients who received a kidney transplant from Maastricht type 2 DCD were included in study. Early graft function and short term outcomes were assessed.

Results: From October 2017 to December 2022, 47 renal grafts were collected from 24 uDCD donors. Median warm ischemia time was 106 min (94-115), cannulation time was 10 min (8; 20) and duration of extracorporeal reperfusion (ANOR) was 180 min (126-214). Regarding early graft function, 25% had immediate graft function, 63.6% had delayed graft function and 11.4% had primary non-function (PNF). There was a correlation between cannulation time (p = 0.006) and ANOR with PNF (p = 0.016).

Conclusions: Cannulation time and ANOR were the main factors that correlated with PNF. Better understanding of underlying mechanisms should be sought in future studies to reduce the incidence of PNF.

Keywords: Abdominal organ normothermic reperfusion; Cannulation time; Kidney transplantation; Maastricht type 2 donation after circulatory death; Primary graft non function.