Kidney donation from children after cardiac death

Objective. Pediatric kidney donation after cardiac death is an underutilized donor source because of ethical concerns and limited knowledge of the outcome after transplantation. The purpose of this study was to report the Dutch experience of kidney transplantation using pediatric donation after cardiac death. Design: Observational cohort study of a series of consecutive kidney transplantations from pediatric donation after cardiac death from January 1995 to July 2006. Setting. Kidneys were procured in seven Dutch procurement areas. Patients: Recipients of kidneys from donors after cardiac death aged 2 to 17 yrs. Measurements and Main Results: Prospectively collected data from the Dutch Organ Transplant Registry were analyzed. Donor, graft, and recipient characteristics of all pediatric donations after cardiac death kidney transplantations were documented. Recipients were followed-up for glomerular filtration rate, graft, and patient survival. Eighty-eight patients were transplanted with 90 pediatric donation-after-cardiac-death kidneys, which was 31% of the total number of transplanted pediatric donor kidneys. In 77% of recipients, organs were procured from controlled donors, after withdrawal of supportive treatment. Of all donors, 9% were younger than age 6 yrs. Two patients received their graft pre-emptively. In the others, the incidence of immediate function, delayed graft function, and primary nonfunction were 49%, 44%, and 7%, respectively. Warm ischemia time >= 25 mins was associated with primary nonfunction. Overall graft and patient survival 5 yrs after transplantation were 80% and 88%, respectively. Graft survival after immediate function and delayed graft function was not different. Conclusions: Kidneys from pediatric donation after cardiac death are suitable for transplantation and may substantially expand the donor pool with good transplant outcome. (Crit Care Med 2010; 38:249-253)