• Hessel Peters-Sengers, Jaap J Homan van der Heide, Heemskerk Martin B A MBA, Ineke J M Ten Berge, Fred C W Ultee, Mirza M Idu, Betjes Michiel G H MGH, Arjan D van Zuilen, Christiaans Maarten H L MHL, Luuk H Hilbrands, de Vries Aiko P J APJ, Azam S Nurmohamed, Stefan P Berger, and Frederike J Bemelman.
• 1 Department of Nephrology, Academic Medical Center, the Netherlands. 2 Dutch Transplant Foundation, Leiden, the Netherlands. 3 Department of Surgery, Academic Medical Center, the Netherlands. 4 Department of Nephrology, Erasmus University Medical Center Rotterdam, the Netherlands. 5 Department of Nephrology, University Medical Center Utrecht, the Netherlands. 6 Department of Nephrology, Maastricht University Medical Center, the Netherlands. 7 Department of Nephrology, Radboud University Medical Center, the Netherlands. 8 Department of Nephrology, Leiden University Medical Center, the Netherlands. 9 Department of Nephrology, VU Medical Center, the Netherlands. 10 Department of Nephrology, University Medical Center Groningen, the Netherlands.
• Transplantation. 2017 Jun 1; 101 (6): 1144-1151.

BackgroundOrgan shortage persists despite a high rate of donation after circulatory death (DCD) in the Netherlands. The median waiting time for a deceased donor kidney in 2013 was 3.5 years. Most DCD kidneys are from controlled DCD (cDCD; Maastricht category III). Experience with uncontrolled donors after cardiac death (uDCD), that is, donors with an unexpected and irreversible cardiac arrest (Maastricht categories I and II), is increasing; and its effect on transplant outcomes needs evaluation.MethodsWe used the Dutch Organ Transplantation Registry to include recipients (≥18 years old) from all Dutch centers who received transplants from 2002 to 2012 with a first DCD kidney. We compared transplant outcome in uDCD (n = 97) and cDCD (n = 1441).ResultsPrimary nonfunction in uDCD was higher than in the cDCD (19.6% vs 9.6%, P < 0.001, respectively). Delayed graft function was also higher in uDCD than in cDCD, but not significantly (73.7% vs 63.3%, P = .074, respectively). If censored for primary nonfunction, estimated glomerular filtration rates after 1 year and 5 years were comparable between uDCD and cDCD (1 year: uDCD, 44.3 (23.4) mL/min/m and cDCD, 45.8 (24.1) mL/min/m; P = 0.621; 5 years: uDCD, 49.1 (25.6) mL/min/m and cDCD, 47.7 (21.7) mL/min/m; P = 0.686). The differences in primary nonfunction between kidneys from uDCD and cDCD were explained by differences in the first warm ischemic period, cold ischemic time, and donor age.ConclusionsWe conclude that uDCD kidneys have potential for excellent function and can constitute a valuable extension of the donor pool. However, further efforts are necessary to address the high rate of primary nonfunction.

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