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      Outcomes of kidneys from donors after cardiac death: implications for allocation and preservation.

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          Abstract

          Although donation after cardiac death (DCD) kidneys have a high incidence of delayed graft function (DGF) and have been considered marginal, no tool for stratifying risk of graft loss nor a specific policy governing their allocation exist. We compared outcomes of 2562 DCD, 62,800 standard criteria donor (SCD) and 12,812 expanded criteria donor (ECD) transplants reported between 1993 and 2005, and evaluated factors associated with risk of graft loss and DGF in DCD kidneys. Donor age was the only criterion used in the definition of ECD kidneys that independently predicted graft loss among DCD kidneys. Kidneys from DCD donors <50 had similar long-term graft survival to those from SCD (RR 1.1, p = NS). While DGF was higher among DCD compared to SCD and ECD, limiting cold ischemia (CIT) to <12 h decreased the rate of DGF 15% among DCD <50 kidneys. These findings suggest that DCD <50 kidneys function like SCD kidneys and should not be viewed as marginal or ECD, and further, limiting CIT <12 h markedly reduces DGF.

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          Author and article information

          Journal
          Am. J. Transplant.
          American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons
          Wiley-Blackwell
          1600-6135
          1600-6135
          Jul 2007
          : 7
          : 7
          Affiliations
          [1 ] Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
          Article
          AJT1852
          10.1111/j.1600-6143.2007.01852.x
          17524076
          afbb6a2b-9514-42f2-b85a-1c4624a543ad

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