Introduction: The big gap between organ demand and supply led to organ shortage. In result, all over the world, more and more are used extended criteria donors, including donors after cardiac death (DCD). The use of such donors associated with warm ischemia time and lack of adequate donor management that can affect transplant outcomes. In our center, according to the Maastricht classification, the 3rd and 4th group DCD are used since 1992 and number of these donors progressively increases. Analysis performed in this report refers to the comparison of renal transplant outcomes using organs from donors after brain death (DBD) and donors after cardiac death, performed in single national transplant center.
Aim of study: To clarify and compare the renal transplant outcomes after transplantation from donors after cardiac death and donors after brain death.
Materials and methods: Study included 351 consecutive primary renal transplantations from deceased donors procured in a single transplant center during the period since 2000 till 2005. Kidneys were recovered from 244 deceased donors at the age of 41.2 ± 13.2 (8 - 68) years. In DCD group donors average age accounted for 42, 7 ± 11,5 years, in control group (DBD) - 39,3 ± 13,5 years. Reason of death was cardiac death in 68 donors, and the brain death in 176 donors. 107 kidney transplantations were performed using organs from donors after cardiac death, and 244 - from donors after brain death. The average age of recipients in DCD group accounted for 45,6 ± 14,5 years, and in DBD group - 44,2 ± 15,0 years. Results of transplantations were compared regarding the type of deceased donors been used.
Results: The percentage of non functioning grafts recovered from donors after cardiac death made up 1.8 % in comparison of 1.6 % in a control group (DBD). Delayed graft function of transplants made up respectively 14.0% and 12.3% (p = NS). In DCD group acute rejection reaction was observed in 30,8 % of recipients, without statistical difference in control group (28,6%). Within a period of 5 years mortality in DCD group made up 15 % and in BDB group 12.3 % (p = NS). Graft survival was respectively 76.7 % and 84.8% (p = 0,046).
Conclusion: Results of study showed acceptable outcomes of kidneys transplants received from donors after cardiac death in comparison with donors after brain death. Long term results in DCD donation should be improved by introduction of new technologies.