Nonutilization of Kidneys From Donors After Circulatory Determinant of Death

Yingxin Lin, BSc; Armando Teixeira-Pinto, PhD; Helen Opdam, MD; Jeremy R. Chapman, MD; Jonathan C. Craig, PhD; Natasha Rogers, PhD; Henry Pleass, PhD; Christopher Davies, PhD; Stephen McDonald, PhD; Jean Yang, PhD; Wai Lim, PhD; Germaine Wong, PhD

doi:10.1097/TXD.0000000000001331

Transplantation Direct (Jun 2022)

Nonutilization of Kidneys From Donors After Circulatory Determinant of Death

Yingxin Lin, BSc,
Armando Teixeira-Pinto, PhD,
Helen Opdam, MD,
Jeremy R. Chapman, MD,
Jonathan C. Craig, PhD,
Natasha Rogers, PhD,
Henry Pleass, PhD,
Christopher Davies, PhD,
Stephen McDonald, PhD,
Jean Yang, PhD,
Wai Lim, PhD,
Germaine Wong, PhD

Affiliations

Yingxin Lin, BSc: 1 Sydney School of Public Health, University of Sydney, Sydney, Australia.
Armando Teixeira-Pinto, PhD: 1 Sydney School of Public Health, University of Sydney, Sydney, Australia.
Helen Opdam, MD: 4 DonateLife, Organ and Tissue Authority, Canberra, Australia.
Jeremy R. Chapman, MD: 5 Centre for Transplant and Renal Research, Westmead Hospital, Sydney, Australia.
Jonathan C. Craig, PhD: 6 College of Medicine and Public Health, Flinders University, Bedford Park, Australia.
Natasha Rogers, PhD: 5 Centre for Transplant and Renal Research, Westmead Hospital, Sydney, Australia.
Henry Pleass, PhD: 7 Specialty of Surgery, University of Sydney, Sydney, Australia.
Christopher Davies, PhD: 8 Australia and New Zealand Dialysis and Transplant Registry, South Australian Health and Medical Research Institute, Adelaide, Australia.
Stephen McDonald, PhD: 8 Australia and New Zealand Dialysis and Transplant Registry, South Australian Health and Medical Research Institute, Adelaide, Australia.
Jean Yang, PhD: 2 Faculty of Science, School of Mathematics and Science, University of Sydney, Sydney, Australia.
Wai Lim, PhD: 11 Medical School, University of Western Australia, Perth, Australia.
Germaine Wong, PhD: 1 Sydney School of Public Health, University of Sydney, Sydney, Australia.

DOI: https://doi.org/10.1097/TXD.0000000000001331
Journal volume & issue: Vol. 8, no. 6
p. e1331

Abstract

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Background. The expansion of donation after circulatory determination of death (DCDD) programs and unmet demands for kidney transplantation indicate that there is a need to improve the efficiency and utilization of these organs. Methods. We studied all DCDD donors retrieved for kidney transplantation in Australia between 2014 and 2019 and determined the factors associated with nonutilization using least absolute shrinkage and selection operator and random forest models. Self-organizing maps were used to group these donors into clusters with similar characteristics and features associated with nonutilization were defined. Results. Of the 762 DCDD donors, 116 (15%) were not utilized for kidney transplantation. Of the 9 clusters derived from self-organizing map, 2 had the highest proportions of nonutilized kidneys. Factors for nonutilization (adjusted odds ratio [95% confidence interval], per SD increase) were duration from withdrawal of cardiorespiratory support till death (1.38 [1.16-1.64]), admission and terminal serum creatinine (1.43 [1.13-1.85]) and (1.41 [1.16-1.73]). Donor kidney function and duration of warm ischemia were the main factors for clinical decisions taken not to use kidneys from DCDD donors. Conclusions. Donor terminal kidney function and the duration of warm ischemia are the key factors for nonutilization of DCDD kidneys. Strategies to reduce the duration of warm ischemia and improve post-transplant recipient kidney function may reduce rates of nonutilization.

Published in Transplantation Direct

ISSN: 2373-8731 (Online)
Publisher: Wolters Kluwer
Country of publisher: United States
LCC subjects: Medicine: Surgery
Website: http://journals.lww.com/transplantationdirect/Pages/default.aspx

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