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!
Neutrons produce first direct 3D maps of water during cell membrane fusion
21.09.2018 | DOE/Oak Ridge National Laboratory
Narcolepsy, scientists unmask the culprit of an enigmatic disease
20.09.2018 | Universitätsspital Bern
The building blocks of matter in our universe were formed in the first 10 microseconds of its existence, according to the currently accepted scientific picture. After the Big Bang about 13.7 billion years ago, matter consisted mainly of quarks and gluons, two types of elementary particles whose interactions are governed by quantum chromodynamics (QCD), the theory of strong interaction. In the early universe, these particles moved (nearly) freely in a quark-gluon plasma.
This is a joint press release of University Muenster and Heidelberg as well as the GSI Helmholtzzentrum für Schwerionenforschung in Darmstadt.
Then, in a phase transition, they combined and formed hadrons, among them the building blocks of atomic nuclei, protons and neutrons. In the current issue of...
Thin-film solar cells made of crystalline silicon are inexpensive and achieve efficiencies of a good 14 percent. However, they could do even better if their shiny surfaces reflected less light. A team led by Prof. Christiane Becker from the Helmholtz-Zentrum Berlin (HZB) has now patented a sophisticated new solution to this problem.
"It is not enough simply to bring more light into the cell," says Christiane Becker. Such surface structures can even ultimately reduce the efficiency by...
A study in the journal Bulletin of Marine Science describes a new, blood-red species of octocoral found in Panama. The species in the genus Thesea was discovered in the threatened low-light reef environment on Hannibal Bank, 60 kilometers off mainland Pacific Panama, by researchers at the Smithsonian Tropical Research Institute in Panama (STRI) and the Centro de Investigación en Ciencias del Mar y Limnología (CIMAR) at the University of Costa Rica.
Scientists established the new species, Thesea dalioi, by comparing its physical traits, such as branch thickness and the bright red colony color, with the...
Scientists have succeeded in observing the first long-distance transfer of information in a magnetic group of materials known as antiferromagnets.
An international team of researchers has mapped Nemo's genome, providing the research community with an invaluable resource to decode the response of fish to...
21.09.2018 | Event News
03.09.2018 | Event News
27.08.2018 | Event News
24.09.2018 | Physics and Astronomy
24.09.2018 | Information Technology
21.09.2018 | Physics and Astronomy