In the last decade physicians and surgeons began using organs from donors who suffered cardiac death [donors after cardiac death (DCD)] as an alternative to organs transplanted after donor brain death (DBD). DBD kidneys are believed to be superior for successful transplant. In DBD transplants, the circulatory system is maintained until the organ is preserved. In contrast, with DCD organs, the shutdown of the circulatory system and the attendant loss of blood supply to the kidney may cause damage to the transplant organ.
In a study appearing in an upcoming issue of the Journal of the American Society of Nephrology, Maarten G. Snoeijs, MD (Maastricht University Medical Center, the Netherlands) and co-authors analyzed 2,575 Dutch transplant candidates to see how receiving a DCD kidney affected their overall chances of survival.
"Over the past decade, DCD has evolved into an important new source of donor kidneys," Snoeijs explained. "However, in many countries the large donor pool of DCD kidneys has not been fully utilized." That is because questions remain as to the benefits of DCD transplants. Are patients better off receiving a DCD kidney or waiting for a kidney donated after brain death?
Kidneys donated after brain death are "generally believed to be superior," according to Snoeijs. However, of the 2,575 wait-listed patients in this study, 26 percent received a DBD kidney and 18 percent received a DCD organ, so more than half either died or remained on the waiting list.
When DCD kidneys were transplanted, the failure rate in the first few months was nearly twice as high as for DBD kidneys. However, patients who received DCD kidneys had a 56 percent higher chance of survival, compared to those who stayed on dialysis waiting for a DBD kidney.
"We think these results may have a large influence on DCD kidney transplantation, which may eventually lead to a substantial reduction of the waiting list and improved survival of patients with end-stage renal disease," said Snoeijs.
The study adds to "the preponderance of evidence" in favor of using DCD organs, according to an accompanying editorial by Nicholas Shah, MD, and Anthony Langone, MD (Vanderbilt University School of Medicine, Nashville, TN). They conclude, "Transplant centers should maximally utilize DCD kidneys to optimize the quality of life and minimize mortality of their patients on the waiting list."
Like other observational studies, the current study is limited by the possibility of selection bias. "Due to careful statistical corrections, however, we consider it unlikely that the effect of DCD kidney transplantation on survival has been overestimated because of patient selection bias," according to Snoeijs.
Disclosures: Dr. Snoeijs was supported by a clinical research trainee grant from the Netherlands Organization for Health Research and Development. Development of the statistical methodology and analysis was supported by National Institutes of Health grant R01 DK-70869 to Douglas E. Schaubel. The authors of the study and editorial declare no conflicts of interest.
Study co-authors were Douglas E. Schaubel, PhD (University of Michigan), Ronald Hené, MD, PhD (University Medical Center Utrecht), Andries J. Hoitsma, MD, PhD (Radboud University Medical Center), Mirza M. Idu, MD, PhD (Academic Medical Center), Jan N. Ijzermans, MD, PhD (Erasmus University Medical Center), Rutger J. Ploeg, MD, PhD (University Medical Center Groningen), Jan Ringers, MD (Leiden University Medical Center), Maarten H Christiaans, MD, PhD, Wim A Buurman, MD, and L.W. Ernest van Heurn, MD (Maastricht University Medical Center).
The article, entitled "Kidneys from Donors after Cardiac Death Provide Survival Benefit" (doi 10.1681/ASN.2009121203) and accompanying editorial, "Renal Donation after Cardiac Death" (doi 10.1681/ASN.2010040415) will appear online at http://jasn.asnjournals.org/ on May 20, 2010.
The American Society of Nephrology (ASN) does not offer medical advice. All content in ASN publications is for informational purposes only, and is not intended to cover all possible uses, directions, precautions, drug interactions, or adverse effects. This content should not be used during a medical emergency or for the diagnosis or treatment of any medical condition. Please consult your doctor or other qualified health care provider if you have any questions about a medical condition, or before taking any drug, changing your diet or commencing or discontinuing any course of treatment. Do not ignore or delay obtaining professional medical advice because of information accessed through ASN. Call 911 or your doctor for all medical emergencies.
Founded in 1966, ASN is the world's largest professional society devoted to the study of kidney disease. Comprised of 11,000 physicians and scientists, ASN continues to promote expert patient care, to advance medical research, and to educate the renal community. ASN also informs policymakers about issues of importance to kidney doctors and their patients. ASN funds research, and through its world-renowned meetings and first-class publications, disseminates information and educational tools that empower physicians.
Shari Leventhal | EurekAlert!
Researchers release the brakes on the immune system
18.10.2017 | Rheinische Friedrich-Wilhelms-Universität Bonn
Norovirus evades immune system by hiding out in rare gut cells
12.10.2017 | University of Pennsylvania School of Medicine
University of Maryland researchers contribute to historic detection of gravitational waves and light created by event
On August 17, 2017, at 12:41:04 UTC, scientists made the first direct observation of a merger between two neutron stars--the dense, collapsed cores that remain...
Seven new papers describe the first-ever detection of light from a gravitational wave source. The event, caused by two neutron stars colliding and merging together, was dubbed GW170817 because it sent ripples through space-time that reached Earth on 2017 August 17. Around the world, hundreds of excited astronomers mobilized quickly and were able to observe the event using numerous telescopes, providing a wealth of new data.
Previous detections of gravitational waves have all involved the merger of two black holes, a feat that won the 2017 Nobel Prize in Physics earlier this month....
Material defects in end products can quickly result in failures in many areas of industry, and have a massive impact on the safe use of their products. This is why, in the field of quality assurance, intelligent, nondestructive sensor systems play a key role. They allow testing components and parts in a rapid and cost-efficient manner without destroying the actual product or changing its surface. Experts from the Fraunhofer IZFP in Saarbrücken will be presenting two exhibits at the Blechexpo in Stuttgart from 7–10 November 2017 that allow fast, reliable, and automated characterization of materials and detection of defects (Hall 5, Booth 5306).
When quality testing uses time-consuming destructive test methods, it can result in enormous costs due to damaging or destroying the products. And given that...
Using a new cooling technique MPQ scientists succeed at observing collisions in a dense beam of cold and slow dipolar molecules.
How do chemical reactions proceed at extremely low temperatures? The answer requires the investigation of molecular samples that are cold, dense, and slow at...
Scientists from the Max Planck Institute of Quantum Optics, using high precision laser spectroscopy of atomic hydrogen, confirm the surprisingly small value of the proton radius determined from muonic hydrogen.
It was one of the breakthroughs of the year 2010: Laser spectroscopy of muonic hydrogen resulted in a value for the proton charge radius that was significantly...
17.10.2017 | Event News
10.10.2017 | Event News
10.10.2017 | Event News
19.10.2017 | Materials Sciences
19.10.2017 | Materials Sciences
19.10.2017 | Physics and Astronomy