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Transplantation of kidneys from DCD and DBD donors who died after ligature asphyxiation: The UK experience.

ABSTRACT: There is uncertainty about whether hypoxic injury accompanying donor death from ligature asphyxiation influences renal transplant outcomes, particularly for recipients of kidneys donated after circulatory death (DCD). The UK Registry analysis was undertaken to determine transplant outcomes in recipients of kidneys from donors who died following ligature asphyxiation. From 2003 to 2016, 2.7% (n = 521) of potential organ donors died following ligature asphyxiation (mostly suicide by hanging). Of these, 409 (78.5%) donated kidneys for transplantation (46.9% donation after brain death [DBD] and 53.1% DCD donors) resulting in 650 kidney transplants. Compared to other deceased donors, those dying from ligature asphyxiation were younger, more often male, and had less hypertension. Unadjusted patient and graft survival were superior for recipients of both DBD and DCD kidneys from donors dying after ligature asphyxiation, although after adjustment for donor/recipient variables, transplant outcomes were similar. A case-control matched analysis confirmed transplant outcomes for those who received kidneys from donors dying after ligature asphyxiation were similar to controls. Although caution is required in interpreting these findings because of potential selection bias, kidneys from donors dying of ligature asphyxiation suffer an additional warm ischemic insult that does not apparently adversely influence transplant outcomes, even for kidneys from DCD donors.

SUBMITTER: Trotter PB

PROVIDER: S-EPMC6221073 | biostudies-literature | 2018 Nov

REPOSITORIES: biostudies-literature

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Transplantation of kidneys from DCD and DBD donors who died after ligature asphyxiation: The UK experience.

Trotter Patrick B PB Jochmans Ina I Hulme William W Robb Matthew M Watson Christopher C Neuberger James J Andrew Bradley J J

American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons 20180730 11

There is uncertainty about whether hypoxic injury accompanying donor death from ligature asphyxiation influences renal transplant outcomes, particularly for recipients of kidneys donated after circulatory death (DCD). The UK Registry analysis was undertaken to determine transplant outcomes in recipients of kidneys from donors who died following ligature asphyxiation. From 2003 to 2016, 2.7% (n = 521) of potential organ donors died following ligature asphyxiation (mostly suicide by hanging). Of t ...[more]

PMID: 29947090

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Project description:ObjectivesTo assess the long term outcomes of transplantation using expanded criteria donors (ECD; donors aged ≥ 60 years or aged 50-59 years with vascular comorbidities) and assess the main determinants of its prognosis.DesignProspective, population based cohort study.SettingFour French referral centres.ParticipantsConsecutive patients who underwent kidney transplantation between January 2004 and January 2011, and were followed up to May 2014. A validation cohort included patients from another four referral centres in France who underwent kidney transplantation between January 2002 and December 2011.Main outcome measuresLong term kidney allograft survival, based on systematic assessment of donor, recipient, and transplant clinical characteristics; preimplantation biopsy; and circulating levels of donor specific anti-HLA (human leucocyte antigen) antibody (DSA) at baseline.ResultsThe study included 6891 patients (2763 in the principal cohort, 4128 in the validation cohort). Of 2763 transplantations performed, 916 (33.2%) used ECD kidneys. Overall, patients receiving ECD transplants had lower allograft survival after seven years than patients receiving transplants from standard criteria donors (SCD; 80% v 88%, P<0.001). Patients receiving ECD transplants who presented with circulating DSA at the time of transplantation had worse allograft survival after seven years than patients receiving ECD kidneys without circulating DSA at transplantation (44% v 85%, P < 0.001). After adjusting for donor, recipient, and transplant characteristics, as well as preimplantation biopsy findings and baseline immunological parameters, the main independent determinants of long term allograft loss were identified as allocation of ECDs (hazard ratio 1.84 (95% confidence interval 1.5 to 2.3); P < 0.001), presence of circulating DSA on the day of transplantation (3.00 (2.3 to 3.9); P < 0.001), and longer cold ischaemia time (> 12 h; 1.53 (1.1 to 2.1); P = 0.011). Recipients of ECD kidneys with circulating DSA showed a 5.6-fold increased risk of graft loss compared with all other transplant therapies (P < 0.001). ECD allograft survival at seven years significantly improved with screening and transplantation in the absence of circulating DSA (P < 0.001) and with shorter (<12 h) cold ischaemia time (P=0.030), respectively. This strategy achieved ECD graft survival comparable to that of patients receiving an SCD transplant overall, translating to a 544.6 allograft life years saved during the nine years of study inclusion time.ConclusionsCirculating DSA and cold ischaemia time are the main independent determinants of outcome from ECD transplantation. Allocation policies to avoid DSA and reduction of cold ischaemia time to increase efficacy could promote wider implement of ECD transplantation in the context of organ shortage and improve its prognosis.

Project description:Pedestrians are one of the most vulnerable groups at the roadside, furthermore, previous research has demonstrated perceptual-motor limitations in individuals with DCD which may put these individuals at even more at risk in the context of road crossing. However, it is unclear whether this is the lived experience of these individuals at the roadside. Furthermore, difficulties with road crossing and safety have been found in other neurodevelopmental disorders but the impact this might have on an individual with co-occurring difficulties is unknown. Therefore, we utilized a questionnaire to survey the lived experience of adults with DCD and parents of children with DCD with the specific objectives of describing behaviors exhibited by adults and children with DCD (the latter reported by parents) at the roadside and to determine the how these individuals perceive road crossing actions. For each of these we compared different co-occurrence groups. We also had one final objective which was not focused on road crossing but more on the general perception of accidents and unrealistic optimism. Individuals with co-occurrences which have previously been linked to unsafe crossing behaviors (i.e., ADHD, ASD, and LD) reported a greater regularity of dangerous looking behavior (forgetting to look, running without looking) and visibility (crossing between cars, crossing when you can't see), these adults and the parents of these children were seemingly aware of the risky nature of these behaviors. When asked "why" crossing ability might be different, perceptual and motor difficulties alongside heightened awareness of risk and lowered awareness of risk were all cited by participants. Unrealistic optimism was not an explanation for the risky behavior in adults with DCD and in fact, these adults demonstrated a clear understanding of the likelihood of accidents. The findings of this study suggest that road crossing is perceived to be more challenging for both children and adults with DCD and this needs to be taken into account when considering remediation for this group.

Dataset Information

Transplantation of kidneys from DCD and DBD donors who died after ligature asphyxiation: The UK experience.

Publications

Transplantation of kidneys from DCD and DBD donors who died after ligature asphyxiation: The UK experience.

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