Impact of Extraction Time During Donation After Circulatory Death Organ Procurement on Kidney Function After Transplantation in The Netherlands

Erika van Straalen; Elsaline Rijkse; AnneLoes van Staa; Paul M Rebers; Hanneke J A M Hagenaars; Jacqueline van de Wetering; Jan N M Ijzermans; Robert C Minnee

doi:10.1097/TXD.0000000000001538

Impact of Extraction Time During Donation After Circulatory Death Organ Procurement on Kidney Function After Transplantation in The Netherlands

Transplant Direct. 2023 Oct 10;9(11):e1538. doi: 10.1097/TXD.0000000000001538. eCollection 2023 Nov.

Authors

Erika van Straalen¹, Elsaline Rijkse¹, AnneLoes van Staa², Paul M Rebers¹, Hanneke J A M Hagenaars¹, Jacqueline van de Wetering³, Jan N M Ijzermans¹, Robert C Minnee¹

Affiliations

¹ Division of Hepatopancreatobiliary and Transplant Surgery, Department of Surgery, Erasmus Medical Center Transplant Institute, Rotterdam, The Netherlands.
² Research Center Innovations in Care, Rotterdam University of Applied Sciences, The Netherlands.
³ Department of Nephrology, Erasmus Medical Center Transplant Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands.

Abstract

Background: In The Netherlands, 60% of deceased-donor kidney offers are after donation after circulatory death. Cold and warm ischemia times are known risk factors for delayed graft function (DGF) and inferior allograft survival. Extraction time is a relatively new ischemia time. During procurement, cooling of the kidneys is suboptimal with ongoing ischemia. However, evidence is lacking on whether extraction time has an impact on DGF if all ischemic periods are included.

Methods: Between 2012 and 2018, 1524 donation after circulatory death kidneys were procured and transplanted in The Netherlands. Donation and transplantation-related data were obtained from the database of the Dutch Transplant Foundation. The primary outcome parameter was the incidence of DGF.

Results: In our cohort, extraction time ranged from 14 to 237 min, with a mean of 62 min (SD 32). In multivariate logistic regression analysis, extraction time was an independent risk factor for incidence of DGF (odds ratio per minute increase 1.008; 95% confidence interval, 1.003-1.013; P = 0.001). The agonal phase, hypoperfusion time, and anastomosis time were not independent risk factors for incidence of DGF.

Conclusions: Considering all known ischemic periods during the donation after the circulatory death process, prolonged kidney extraction time increased the risk of DGF after kidney transplantation.